Stephen Raymond Small, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1506 Issued in ME

Practice address

26 Portland Street
Portland, ME 04101

Phone

(207) 761-8402

Fax

(207) 761-8405

NPI assigned

May 16, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Goodwill Industries of Northern New England

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Portland, ME
  • NPI 1588785463

  Physical Therapist

  NPD

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513209600000",
    "number": "1780891481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 WASHINGTON AVE",
            "address_2": "STE 300",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012665",
            "telephone_number": "207-761-8402",
            "fax_number": "207-761-8405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 PORTLAND STREET",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04101",
            "telephone_number": "207-761-8402",
            "fax_number": "207-761-8405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALL",
        "first_name": "STEPHEN",
        "middle_name": "RAYMOND",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2017-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT1506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "061343",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jane Sloven, L.C.S.W.
• Rachel Anne Sluder, DO
• Betty Bricker Small, ANP
• Katie Marie Small, LCSW
• Molly Erin Small
• Cami Renee Smalley, MS
• Karina Smegal
• Nicole Smeltzer, LMSW-CC
• Danielle Smerald, OTR/L
• Smile Clinic, LLC

• Physical Therapist in Portland, ME
• Providers in Portland, ME by specialty
• Physical Therapist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; 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.