Provider Demographics
NPI:1750814018
Name:DOUGHTY FALLS PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:DOUGHTY FALLS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DUBAY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:207-676-9596
Mailing Address - Street 1:73 ELM ST
Mailing Address - Street 2:PO BOX 611
Mailing Address - City:NORTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03906-6724
Mailing Address - Country:US
Mailing Address - Phone:207-676-9596
Mailing Address - Fax:207-676-9707
Practice Address - Street 1:73 ELM ST
Practice Address - Street 2:
Practice Address - City:NORTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03906-6724
Practice Address - Country:US
Practice Address - Phone:207-676-9596
Practice Address - Fax:207-676-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty