Provider Demographics
NPI:1023214871
Name:CENTRAL MASSACHUSETTS PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:CENTRAL MASSACHUSETTS PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-667-0281
Mailing Address - Street 1:176 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2462
Mailing Address - Country:US
Mailing Address - Phone:508-667-0281
Mailing Address - Fax:
Practice Address - Street 1:354 W BOYLSTON ST STE 111
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2373
Practice Address - Country:US
Practice Address - Phone:508-852-3700
Practice Address - Fax:508-852-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy