Provider Demographics
NPI:1982672671
Name:DOUGLAS, MATTHEW S (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:S
Last Name:DOUGLAS
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 1:50 FOREST FALLS DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096
Mailing Address - Country:US
Mailing Address - Phone:207-846-8725
Mailing Address - Fax:207-846-8728
Practice Address - Street 1:50 FOREST FALLS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6937
Practice Address - Country:US
Practice Address - Phone:207-846-8725
Practice Address - Fax:207-846-8728
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME060023OtherANTHEM BCBS
ME2756063001OtherCIGNA
ME626281OtherHARVARD PILGRIM
ME2756063001OtherCIGNA