Provider Demographics
NPI:1770752438
Name:PICKLE, DAVID JAMES (MSPT, DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:PICKLE
Suffix:
Gender:M
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROCKWOOD DRIVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-0552
Mailing Address - Country:US
Mailing Address - Phone:207-626-3333
Mailing Address - Fax:207-626-3334
Practice Address - Street 1:6 ROCKWOOD DRIVE
Practice Address - Street 2:SUITE #2
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-0552
Practice Address - Country:US
Practice Address - Phone:207-626-3333
Practice Address - Fax:207-626-3334
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME060722OtherBLUE CROSS & BLUE SHIELD
ME162260000Medicaid
ME060722OtherBLUE CROSS & BLUE SHIELD