Provider Demographics
NPI:1073681300
Name:PHYSICAL THERAPY & SPORTS REHAB INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY & SPORTS REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VACOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-784-1600
Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:STE 280
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-769-2040
Mailing Address - Fax:781-769-1914
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:STE 280
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-769-2040
Practice Address - Fax:781-769-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT0041Medicare ID - Type Unspecified