Ethan Daigneault, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT6519 Issued in ME

Practice address

22 Bramhall St
Portland, ME 04102-3134

Phone

(207) 662-0111

NPI assigned

Jun 8, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Portland Physical Therapy LLCGroup PAC ID 9931418191, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Portland Physical Therapy LLC

  • Physical Therapist
  • Portland, ME
  • NPI 1528436052
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1063106334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 TOWNHOUSE RD",
            "city": "EAST WATERBORO",
            "state": "ME",
            "postal_code": "040305700",
            "telephone_number": "207-636-6629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAIGNEAULT",
        "first_name": "ETHAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-08",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT6519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ayanle Ali Dahir
• Merrilee Dahm Larsen, LCPC
• Kathy Dahms, FNP
• Heather Daigle, MD
• Jennifer Kendra Daigle, N.P.
• Brian E Daikh, MD
• Patrick Robert Daisley, APRN-CRNA
• Raeann Dalton, DO
• Daly Grace PA
• Cheryl Ann Daly, LCSW

• Physical Therapist in Portland, ME
• Providers in Portland, ME by specialty
• Physical Therapist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.