Rurik Samual Brackett
Individual provider Active NPI Physical Therapist · Portland, ME
NPI 1962277947 · NPPES record last updated Nov 20, 2023
Key facts
- NPI
- 1962277947
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT6670 (ME)
- Practice address
- 331 Veranda St Ste 401
Portland, ME 04103-5545 - Phone
- (207) 536-0702
- Fax
- (207) 536-0785
- NPI assigned
- Nov 20, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pinnacle Rehabilitation Network LLC
Practice addresses (Care Compare)
152 US Route 1
Suite 9
Scarborough, ME 04074-8366
Phone (207) 772-7662
74 Gray Rd
Falmouth, ME 04105-2062
Phone (207) 797-3006
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231130002956 | ME | Practitioner - Physical Therapist in Private Practice | 0042668089 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT6670 | ME | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pinnacle Rehabilitation Network, LLC | Physical Therapist | Current |
Accepting new patients |
| Pinnacle Rehabilitation Network, LLC | Physical Therapist | Current | Accepting new patients |
| Pinnacle Rehabilitation Network LLC | Physical Therapist | Current |
Accepting new patients |
Locations
74 Gray Rd
Falmouth, ME 04105
Phone (207) 774-3070
331 Veranda St
Ste 401
Portland, ME 04103
Phone (207) 536-0702
152 US Route 1
Ste 9
Scarborough, ME 04074
Phone (207) 772-7662
73 Newton Rd
Unit 101
Plaistow, NH 03865
Phone (978) 388-7272
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT6670 | ME | Yes |
Addresses
Primary practice location
331 Veranda St Ste 401
Portland, ME 04103-5545
Mailing address
73 Newton Rd Unit 101
Plaistow, NH 03865-2440
Phone (978) 388-7272
Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.