Individual provider Active NPI

Marley Harmon, DPT

  • Physical Therapist
  • Bangor, ME
National Provider Identifier
1275148579
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT5755 Issued in ME
Practice address
242 State St
Bangor, ME 04401-5415
Phone
(207) 922-4900
NPI assigned
Sep 14, 2020
Last updated
Sep 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT5755 ME Primary

Addresses

Primary practice location

242 State St
Bangor, ME 04401-5415

Mailing address

278A State St
Brewer, ME 04412-1519
Phone (207) 922-4900

Other practice location 1

278A State St
Brewer, ME 04412-1519
Phone (207) 922-4900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201022003009 ME Practitioner - Physical Therapist in Private Practice 0042630451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Performance Physical Therapy and Sports Rehab IncGroup PAC ID 1052632932, 6 clinicians

Practice addresses (Care Compare)

278 State St
Brewer, ME 04412-1519
Phone (207) 922-4900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT5755MEMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Performance Physical Therapy and Sports Rehab Inc. Physical Therapist CurrentSince Oct 1, 2020 Accepting new patients

Locations

242 State St
Bangor, ME 04401
Phone (207) 922-4000

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

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

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

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1275148579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "278A STATE ST",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121519",
            "telephone_number": "207-922-4900",
            "fax_number": "207-922-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015415",
            "telephone_number": "207-922-4900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "278A State St",
            "address_purpose": "LOCATION",
            "city": "Brewer",
            "state": "ME",
            "postal_code": "044121519",
            "country_code": "US",
            "telephone_number": "207-922-4900",
            "fax_number": "207-922-4901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARMON",
        "first_name": "MARLEY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-14",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT5755",
            "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 Sep 14, 2020; 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.