Provider Demographics
NPI:1427202712
Name:SOSPT, INC.
Entity Type:Organization
Organization Name:SOSPT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MS
Authorized Official - Phone:781-263-9977
Mailing Address - Street 1:148 LINDEN ST
Mailing Address - Street 2:STE B-8
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7900
Mailing Address - Country:US
Mailing Address - Phone:781-263-9977
Mailing Address - Fax:
Practice Address - Street 1:148 LINDEN ST
Practice Address - Street 2:STE B-8
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7900
Practice Address - Country:US
Practice Address - Phone:781-263-9977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8253261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy