Provider Demographics
NPI:1023028636
Name:SEEKONK PHYSICAL THERAPY SERVICES INC
Entity Type:Organization
Organization Name:SEEKONK PHYSICAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-336-5233
Mailing Address - Street 1:1563 FALL RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3736
Mailing Address - Country:US
Mailing Address - Phone:508-336-5233
Mailing Address - Fax:508-336-7245
Practice Address - Street 1:1563 FALL RIVER AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-3736
Practice Address - Country:US
Practice Address - Phone:508-336-5233
Practice Address - Fax:508-336-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SEPT0069Medicare ID - Type UnspecifiedGROUP NUMBER
Y6524BMedicare PIN