NPIMap

Organization Active NPI

Southern Maine Physical Therapy

  • Physical Therapist
  • South Portland, ME
National Provider Identifier
1699875674
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SOUTHERN MAINE PHYSICAL THERAPY
Practice address
449 Cottage Rd
South Portland, ME 04106-4924
Phone
(207) 799-9700
Fax
(207) 799-9706
NPI assigned
Sep 22, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Brenda Ayre, PT/OWNERNPI 1558480970
Title
Owner
Phone
(207) 799-9700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X ME Primary

Addresses

Primary practice location

449 Cottage Rd
South Portland, ME 04106-4924

Mailing address

449 Cottage Rd
South Portland, ME 04106-4924
Phone (207) 799-9700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040825001237 ME Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3678547478 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Biddeford, ME; South Portland, ME

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Southern Maine Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

17 Lincoln St
Ste 016
Biddeford, ME 04005
Phone (207) 799-9700

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1699875674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "449 COTTAGE RD",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041064924",
            "telephone_number": "207-799-9700",
            "fax_number": "207-799-9706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "449 COTTAGE RD",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041064924",
            "telephone_number": "207-799-9700",
            "fax_number": "207-799-9706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAINE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "AYRE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-799-9700",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT/OWNER"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.