Provider Demographics
NPI:1053446989
Name:GREENLOCK THERAPEUTIC RIDING CENTER
Entity Type:Organization
Organization Name:GREENLOCK THERAPEUTIC RIDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:B
Authorized Official - Last Name:WISLOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-252-5814
Mailing Address - Street 1:55 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-2221
Mailing Address - Country:US
Mailing Address - Phone:508-252-5814
Mailing Address - Fax:508-252-5814
Practice Address - Street 1:59 SUMMER ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-2221
Practice Address - Country:US
Practice Address - Phone:508-252-5814
Practice Address - Fax:508-252-5814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty