Provider Demographics
NPI:1780991554
Name:BERUBE, ALLISON B (PT)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:B
Last Name:BERUBE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MAIN RD N
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1657
Mailing Address - Country:US
Mailing Address - Phone:207-942-1890
Mailing Address - Fax:
Practice Address - Street 1:28A MAIN RD S
Practice Address - Street 2:SPECIAL ED.
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1303
Practice Address - Country:US
Practice Address - Phone:207-862-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT21272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics