NPIMap

Organization Active NPI

Pouzol Physical Therapy, PA

  • Physical Therapist
  • Bangor, ME
National Provider Identifier
1982790945
Registry record updated Nov 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
744 Issued in ME
Legal business name
POUZOL PHYSICAL THERAPY, PA
Practice address
33 Penn Plaza
Suite B
Bangor, ME 04401
Phone
(207) 990-2050
Fax
(207) 990-2051
NPI assigned
Oct 5, 2006
Last updated
Nov 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2016

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

Authorized official

Name
Mr. Douglas J Kiny, PT
Title
Owner
Phone
(207) 990-2050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 744 ME Primary

Addresses

Primary practice location

33 Penn Plaza
Suite B
Bangor, ME 04401

Mailing address

33 Penn Plaza
Suite B
Bangor, ME 04401
Phone (207) 990-2050

Other identifiers 1

IdentifierTypeStateIssuer
124440000MedicaidME

Other names 1

  • Philip Pouzol Physical Therapy, PA Former legal business name

National Provider Directory

National Provider Directory

Locations

33 Penn Plz
#B
Bangor, ME 04401
Phone (207) 990-2050

33B Penn Plz
Bangor, ME 04401
Phone (207) 990-2050

33B Penn Plz
Ste B
Bangor, ME 04401

Practitioners & affiliated clinicians

Practitioners 6

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": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479772800000",
    "number": "1982790945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 PENN PLAZA",
            "address_2": "SUITE B",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-990-2050",
            "fax_number": "207-990-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 PENN PLAZA",
            "address_2": "SUITE B",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-990-2050",
            "fax_number": "207-990-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUZOL PHYSICAL THERAPY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2016-11-22",
        "status": "A",
        "authorized_official_last_name": "KINY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-990-2050",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124440000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Philip Pouzol Physical Therapy, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Nov 22, 2016; 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.