Active NPI
Raven R Fulford, PT
- Physical Therapist
- Scarborough, ME
National Provider Identifier
1760927347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT4184
- Practice address
- 55 Spring Street
Scarborough, ME 04074 - Phone
- (207) 396-7337
- Fax
- (207) 885-4349
- NPI assigned
- Jan 5, 2017
- Last updated
- Feb 27, 2018
- 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 | PT4184 | ME | Primary |
Addresses
Primary practice location
55 Spring Street
Scarborough, ME 04074
Mailing address
190 Riverside St
Suite 6B
Portland, ME 04103-1073
Phone (207) 661-2000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E400360799 | Medicaid | ME |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT4184 | ME | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519689600000",
"number": "1760927347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 RIVERSIDE ST",
"address_2": "SUITE 6B",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041031073",
"telephone_number": "207-661-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 SPRING STREET",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "04074",
"telephone_number": "207-396-7337",
"fax_number": "207-885-4349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULFORD",
"first_name": "RAVEN",
"middle_name": "R",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-05",
"last_updated": "2018-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ME",
"license": "PT4184",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "E400360799",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scarborough, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.