Provider Demographics
NPI:1780720128
Name:MASSEY, BRIGITTE J (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:J
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FOREST PARK
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5168
Mailing Address - Country:US
Mailing Address - Phone:207-873-9925
Mailing Address - Fax:207-877-0290
Practice Address - Street 1:234 COLLEGE AVE
Practice Address - Street 2:ORTHOPEDIC THERAPY ASSOCIATES
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6226
Practice Address - Country:US
Practice Address - Phone:207-873-5503
Practice Address - Fax:270-877-0920
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265190099Medicaid
MEMM8228Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER