Provider Demographics
NPI:1134106446
Name:PHYSICAL THERAPY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY HEALTH SERVICES, INC
Other - Org Name:PHYSICAL THERAPY HEALTH CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAILHOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-331-2620
Mailing Address - Street 1:95 WASHINGTON ST
Mailing Address - Street 2:STE 462
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4006
Mailing Address - Country:US
Mailing Address - Phone:781-828-7920
Mailing Address - Fax:781-828-7951
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:STE 462
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4006
Practice Address - Country:US
Practice Address - Phone:781-828-7920
Practice Address - Fax:781-828-7951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0031OtherMEDICARE PTAN