NPIMap

Organization Active NPI

Edgewater Orthopedic Physical Therapy, LLC

  • Physical Therapist
  • Falmouth, ME
National Provider Identifier
1053518332
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3114 Issued in ME
Legal business name
EDGEWATER ORTHOPEDIC PHYSICAL THERAPY, LLC
Practice address
98 Clearwater Dr
Suite 3
Falmouth, ME 04105
Phone
(207) 781-9885
NPI assigned
Jun 29, 2007
Last updated
Nov 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jill Pelletier, DPTNPI 1770693350
Title
Co-Owner Physical Therapist
Phone
(415) 425-1524

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 3114 ME Primary

Addresses

Primary practice location

98 Clearwater Dr
Suite 3
Falmouth, ME 04105

Mailing address

74 Vesper St
Portland, ME 04101-4432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071107000535 ME Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2961599907 Receives reassigned benefits from 11 practitioners
Practice locations: Portland, ME; Falmouth, ME

National Provider Directory

National Provider Directory

Locations

98 Clearwater Dr
Ste 3
Falmouth, ME 04105
Phone (207) 781-9885

631 Stevens Ave
Ste 106
Portland, ME 04103
Phone (207) 781-9885

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1053518332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 VESPER ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 CLEARWATER DR",
            "address_2": "SUITE 3",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "04105",
            "telephone_number": "207-781-9885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWATER ORTHOPEDIC PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "PELLETIER",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "CO-OWNER PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "415-425-1524",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "3114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falmouth, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.