Provider Demographics
NPI:1194004630
Name:PTC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PTC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DANSEREAU
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:508-399-1782
Mailing Address - Street 1:PO BOX 7242
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-0894
Mailing Address - Country:US
Mailing Address - Phone:508-399-1782
Mailing Address - Fax:888-802-0652
Practice Address - Street 1:734 NEWPORT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5935
Practice Address - Country:US
Practice Address - Phone:508-399-1782
Practice Address - Fax:888-802-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15260261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy