Provider Demographics
NPI:1114016847
Name:ONE80 PHYSICAL THERAPY, LLC.
Entity Type:Organization
Organization Name:ONE80 PHYSICAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-658-1999
Mailing Address - Street 1:226 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1022
Mailing Address - Country:US
Mailing Address - Phone:978-658-1999
Mailing Address - Fax:978-658-9994
Practice Address - Street 1:226 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-1022
Practice Address - Country:US
Practice Address - Phone:978-658-1999
Practice Address - Fax:978-658-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12144261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy