Provider Demographics
NPI:1982161683
Name:PHILBROOK, DWAINE LESLIE (PT)
Entity Type:Individual
Prefix:
First Name:DWAINE
Middle Name:LESLIE
Last Name:PHILBROOK
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 1:19 HAYFORD LN
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7575
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 NORTHPORT AVE
Practice Address - Street 2:REHAB SERVICES
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915
Practice Address - Country:US
Practice Address - Phone:207-505-4822
Practice Address - Fax:207-930-2649
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist