Provider Demographics
NPI:1184029183
Name:PROVINCETOWN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PROVINCETOWN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:774-216-0834
Mailing Address - Street 1:30 CONWELL ST
Mailing Address - Street 2:OFFICE #1
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1548
Mailing Address - Country:US
Mailing Address - Phone:774-216-0834
Mailing Address - Fax:508-487-1218
Practice Address - Street 1:30 CONWELL ST
Practice Address - Street 2:OFFICE #1
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1548
Practice Address - Country:US
Practice Address - Phone:774-216-0834
Practice Address - Fax:508-487-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty