Provider Demographics
NPI:1801024633
Name:URBAN, PRISCILLA (LMT, CDT)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:URBAN
Suffix:
Gender:F
Credentials:LMT, CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04098-1013
Mailing Address - Country:US
Mailing Address - Phone:207-856-6447
Mailing Address - Fax:207-856-6447
Practice Address - Street 1:547 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3105
Practice Address - Country:US
Practice Address - Phone:207-856-6447
Practice Address - Fax:207-856-6447
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT515225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048335OtherANTHEM BLUE CROSS BLUE SHIELD OF MAINE