Provider Demographics
NPI:1437508421
Name:DOCTORS PHYSIO,INC
Entity Type:Organization
Organization Name:DOCTORS PHYSIO,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-731-1004
Mailing Address - Street 1:221 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5322
Mailing Address - Country:US
Mailing Address - Phone:617-731-1001
Mailing Address - Fax:
Practice Address - Street 1:221 MOODY ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5322
Practice Address - Country:US
Practice Address - Phone:617-731-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18216261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy