Provider Demographics
NPI:1902906399
Name:FOOTHILLS PHYSICAL THERAPY, PA
Entity Type:Organization
Organization Name:FOOTHILLS PHYSICAL THERAPY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:THOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:207-625-4300
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:CORNISH
Mailing Address - State:ME
Mailing Address - Zip Code:04020-0048
Mailing Address - Country:US
Mailing Address - Phone:207-625-4300
Mailing Address - Fax:207-625-7300
Practice Address - Street 1:16 OLD PIKE RD
Practice Address - Street 2:
Practice Address - City:CORNISH
Practice Address - State:ME
Practice Address - Zip Code:04020-3506
Practice Address - Country:US
Practice Address - Phone:207-625-4300
Practice Address - Fax:207-625-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431998700Medicaid
ME431998700Medicaid