Organization
SUCCESS PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY C. MITCHELL (OWNER/MANAGER)
(207) 874-7992
Entity
Organization
Contact information
Practice address
43 BAXTER BLVD, PORTLAND, ME 04101-1823
(207) 874-7992
(207) 774-9156
Mailing address
43 BAXTER BLVD, PORTLAND, ME 04101-1823
(207) 874-7992
(207) 774-9156
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016708
ANTHEM PROVIDER NUMBER
ME
01
—
1041654
AETNA PROVIDER #
ME
01
—
MN 2183
HARVARD IDENTIFICATION #
ME
Enumeration date
02/23/2006
Last updated
08/22/2020
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