Randy Kenneth Cyr Jr., P.T.
Individual provider Active NPI Physical Therapist · Orono, ME
NPI 1134432263 · NPPES record last updated Jul 18, 2010
Key facts
- NPI
- 1134432263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT1819 (ME)
- Practice address
- 117 Bennoch Rd
Orono, ME 04473-3620 - Phone
- (207) 827-7487
- Fax
- (207) 866-3821
- NPI assigned
- Jul 18, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Back in Motion Physical Therapy LLC
Practice addresses (Care Compare)
94 Main St
Gorham, ME 04038-1340
Phone (207) 839-5860
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170414000180 | ME | Practitioner - Physical Therapist in Private Practice | 1557638517 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT1819 | ME | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Back in Motion Physical Therapy, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
117 Broadway
Ste 1
Bangor, ME 04401
Phone (207) 990-0188
94 Main St
Gorham, ME 04038
Phone (207) 839-5225
482 Stillwater Ave
Old Town, ME 04468
Phone (207) 827-4100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT1819 | ME | Yes |
Addresses
Primary practice location
117 Bennoch Rd
Orono, ME 04473-3620
Mailing address
117 Bennoch Rd
Orono, ME 04473-3620
Phone (207) 827-7487
Other providers in Orono, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.