Provider Demographics
NPI:1780790543
Name:LEGERE, JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:LEGERE
Suffix:
Gender:M
Credentials:PT
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 6073
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-6073
Mailing Address - Country:US
Mailing Address - Phone:207-781-2543
Mailing Address - Fax:207-781-5077
Practice Address - Street 1:361 US ROUTE 1
Practice Address - Street 2:STE 4
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105
Practice Address - Country:US
Practice Address - Phone:207-781-2543
Practice Address - Fax:207-781-5077
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME099241OtherANTHEM BLUE CROSS BLUE SH
ME099241OtherANTHEM BLUE CROSS BLUE SH