Active NPI
Christine Marie Dastalto, PT
- Physical Therapist
- Portland, ME
National Provider Identifier
1194915355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT3192
- Practice address
- 331 Veranda Street
Portland, ME 04103 - Phone
- (207) 874-1125
- Fax
- (207) 874-1127
- NPI assigned
- Jul 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT3192 | ME | Primary |
Addresses
Primary practice location
331 Veranda Street
Portland, ME 04103
Mailing address
331 Veranda Street
Portland, ME 04103
Phone (207) 874-1125
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 098571 | Other | ME | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT3192 | ME | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185321600000",
"number": "1194915355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "331 VERANDA STREET",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04103",
"telephone_number": "207-874-1125",
"fax_number": "207-874-1127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "331 VERANDA STREET",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04103",
"telephone_number": "207-874-1125",
"fax_number": "207-874-1127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DASTALTO",
"first_name": "CHRISTINE",
"middle_name": "MARIE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-25",
"last_updated": "2007-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ME",
"license": "PT3192",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "098571",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.