Provider Demographics
NPI:1740711159
Name:LADD, ROBIN (RPT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:LADD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0722
Mailing Address - Country:US
Mailing Address - Phone:207-864-3332
Mailing Address - Fax:207-864-9224
Practice Address - Street 1:25 DALLAS HILL RD
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970
Practice Address - Country:US
Practice Address - Phone:207-864-3332
Practice Address - Fax:207-864-9224
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPT674OtherPT LICENSE