Provider Demographics
NPI:1033381694
Name:GREATER NEW BEDFORD PHYSICAL THERAPY AND SPORTS REHABILITATION INC.
Entity Type:Organization
Organization Name:GREATER NEW BEDFORD PHYSICAL THERAPY AND SPORTS REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-998-8517
Mailing Address - Street 1:2834 ACUSHNET AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-3412
Mailing Address - Country:US
Mailing Address - Phone:508-998-8517
Mailing Address - Fax:
Practice Address - Street 1:2834 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-3412
Practice Address - Country:US
Practice Address - Phone:508-998-8517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA152325Medicare UPIN