| Organization Name: | BUCKSPORT PHYSICAL THERAPY, LLC |
| NPI Number: | 1952629214 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIM L DE VERSTERRE (OWNER) |
| Mailing Address: | 34 Us Route 1 Bucksport |
| State: | ME US |
| Postal Code: | 044160901 |
| Phone Number: | 2074690786 |
| Fax Number: | 2074699975 |
| NPI Enumeration Date: | 05/12/2010 |
| NPI Last Update Date: | 07/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | PT2563 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |