Provider Demographics
NPI:1336685221
Name:ANCHOR PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ANCHOR PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOROK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, MBA
Authorized Official - Phone:401-284-0770
Mailing Address - Street 1:46 HOLLEY ST
Mailing Address - Street 2:STE 3
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3326
Mailing Address - Country:US
Mailing Address - Phone:401-714-4627
Mailing Address - Fax:
Practice Address - Street 1:46 HOLLEY ST
Practice Address - Street 2:STE 3
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3326
Practice Address - Country:US
Practice Address - Phone:401-284-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01978261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007058118Medicare UPIN