Provider Demographics
NPI:1336325224
Name:SOLEIL PHYSICAL THERAPY & WELLNESS, INC
Entity Type:Organization
Organization Name:SOLEIL PHYSICAL THERAPY & WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARNET
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-376-3232
Mailing Address - Street 1:1223 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4342
Mailing Address - Country:US
Mailing Address - Phone:617-376-3232
Mailing Address - Fax:617-376-3234
Practice Address - Street 1:1223 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4342
Practice Address - Country:US
Practice Address - Phone:617-376-3232
Practice Address - Fax:617-376-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA433261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084274AMedicaid
MA0009933Medicare PIN