NPIMap

Organization Active NPI

Deabay Mobile Physical Therapy, LLC

  • Physical Therapist
  • Bangor, ME
National Provider Identifier
1790419976
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
DEABAY MOBILE PHYSICAL THERAPY, LLC
Practice address
336 Mount Hope Ave Ste 9
Bangor, ME 04401-4236
Phone
(207) 249-6621
Fax
(207) 512-1254
NPI assigned
Jul 13, 2022
Last updated
Apr 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Authorized official

Name
Ann Covey
Title
Billing Manager
Phone
(207) 949-0533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

336 Mount Hope Ave Ste 9
Bangor, ME 04401-4236

Mailing address

62 Graham Ave S
Bangor, ME 04401-5879
Phone (207) 249-6621

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221026001136 ME Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4486020823 Receives reassigned benefits from 6 practitioners
Practice locations: Bangor, ME

National Provider Directory

National Provider Directory

Locations

336 Mount Hope Ave
Ste 9
Bangor, ME 04401
Phone (207) 249-6621

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1790419976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 GRAHAM AVE S",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015879",
            "telephone_number": "207-249-6621",
            "fax_number": "207-512-1254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 MOUNT HOPE AVE STE 9",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014236",
            "telephone_number": "207-249-6621",
            "fax_number": "207-512-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEABAY MOBILE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "COVEY",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "207-949-0533"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "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 Apr 4, 2024; 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.