| Organization Name: | UNIVERSITY OF MAINE |
| NPI Number: | 1437520764 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MOUZON BASS (AGENT) |
| Mailing Address: | 5747 Memorial Gym Orono |
| State: | ME US |
| Postal Code: | 044695747 |
| Phone Number: | 2075811072 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2015 |
| NPI Last Update Date: | 10/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251S0007X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Sports |
| Taxonomy Definition: | |