NPIMap

Organization Active NPI

Performance Physical Therapy and Sports Rehab Inc.

  • Physical Therapist
  • Bangor, ME
National Provider Identifier
1215333554
Registry record updated Nov 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4035 Issued in ME
Legal business name
PERFORMANCE PHYSICAL THERAPY AND SPORTS REHAB INC.
Practice address
277 State St
Suite 1B
Bangor, ME 04401-5439
Phone
(207) 356-9810
NPI assigned
Nov 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2014

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

Authorized official

Name
Bradley Lawrence Libby, PT, DPTNPI 1932533262
Title
Ceo/Physical Therapist
Phone
(207) 356-9810

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT4035 ME Primary

Addresses

Primary practice location

277 State St
Suite 1B
Bangor, ME 04401-5439

Mailing address

95 Sunset Strip
Brewer, ME 04412-1632

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150603002411 ME Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1052632932 Receives reassigned benefits from 7 practitioners
Practice locations: Bangor, ME; Brewer, ME

National Provider Directory

National Provider Directory

Locations

278 State St
#A
Brewer, ME 04412
Phone (207) 922-4900

238 State St
Ste 35
Brewer, ME 04412

277 State St
Brewer, ME 04412
Phone (207) 922-4900

278 State St
Brewer, ME 04412
Phone (207) 922-4900

Practitioners & affiliated clinicians

Practitioners 10

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": "1415923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415923200000",
    "number": "1215333554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 SUNSET STRIP",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 STATE ST",
            "address_2": "SUITE 1B",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015439",
            "telephone_number": "207-356-9810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PHYSICAL THERAPY AND SPORTS REHAB INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-14",
        "last_updated": "2014-11-14",
        "status": "A",
        "authorized_official_last_name": "LIBBY",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "CEO/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "207-356-9810",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT4035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; 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.