Basic Information
| Provider Information | |||||||||
| NPI: | 1184793416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAMP | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077950111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 690 MINOT AVENUE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | AUBURN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077833450 | ||||||||
| FaxNumber: | 2077773979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT1835 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 061589 | 01 | ME | ANTHEM | OTHER | 261610099 | 05 | ME | MEDICAID |