Provider Demographics
NPI:1417170796
Name:TEAMWORK PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:TEAMWORK PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:AUDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-847-0066
Mailing Address - Street 1:618 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7335
Mailing Address - Country:US
Mailing Address - Phone:617-847-0066
Mailing Address - Fax:617-847-0908
Practice Address - Street 1:696 PLAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2100
Practice Address - Country:US
Practice Address - Phone:781-834-0041
Practice Address - Fax:781-837-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5691690006Medicare NSC