NPIMap

Organization Active NPI

Port City Physical Therapy

  • Athletic Trainer
  • Portland, ME
National Provider Identifier
1740248996
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
AT233 Issued in ME
Legal business name
PORT CITY PHYSICAL THERAPY
Practice address
94 Auburn St
Suite 103 Port City Physical Therapy
Portland, ME 04106
Phone
(207) 797-7578
Fax
(207) 797-8165
NPI assigned
May 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert J Sullivan, M ED ATC
Title
Athletic Trainer
Phone
(617) 515-5915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic TrainerGroup: 193400000X SINGLE SPECIALTY GROUP 2255A2300X AT233 ME Primary

Addresses

Primary practice location

94 Auburn St
Suite 103 Port City Physical Therapy
Portland, ME 04106

Mailing address

94 Auburn St
Suite 103
Portland, ME 04103
Phone (207) 797-7578

National Provider Directory

National Provider Directory
Tax ID family
Port City Physical Therapy Limited Partnership4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740248996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 AUBURN ST",
            "address_2": "SUITE 103",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-797-7578",
            "fax_number": "207-797-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 AUBURN ST",
            "address_2": "SUITE 103 PORT CITY PHYSICAL THERAPY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04106",
            "telephone_number": "207-797-7578",
            "fax_number": "207-797-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT CITY PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ATHLETIC TRAINER",
        "authorized_official_telephone_number": "617-515-5915",
        "authorized_official_credential": "M ED ATC"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT233",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.