Provider Demographics
NPI:1316229602
Name:SPORTS MEDICINE INC.
Entity Type:Organization
Organization Name:SPORTS MEDICINE INC.
Other - Org Name:D/B/A ORTHOPEDIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-773-3379
Mailing Address - Street 1:306A HIGH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2611
Mailing Address - Country:US
Mailing Address - Phone:413-773-3379
Mailing Address - Fax:713-772-2705
Practice Address - Street 1:306A HIGH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2611
Practice Address - Country:US
Practice Address - Phone:413-773-3379
Practice Address - Fax:713-772-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2976133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty