Provider Demographics
NPI:1174686208
Name:STIM ATHLETIC THERAPY INC.
Entity Type:Organization
Organization Name:STIM ATHLETIC THERAPY INC.
Other - Org Name:SPORTS CENTER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BROCKLEBANK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:508-548-7491
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02541-0593
Mailing Address - Country:US
Mailing Address - Phone:508-548-7491
Mailing Address - Fax:508-457-4907
Practice Address - Street 1:33 HIGHFIELD DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2303
Practice Address - Country:US
Practice Address - Phone:508-548-7491
Practice Address - Fax:508-457-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
388229OtherEMDEON