Provider Demographics
NPI:1477675916
Name:WALPOLE PHYSICAL THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:WALPOLE PHYSICAL THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:BSPT
Authorized Official - Phone:508-668-5732
Mailing Address - Street 1:420 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3753
Mailing Address - Country:US
Mailing Address - Phone:508-668-5732
Mailing Address - Fax:508-668-6250
Practice Address - Street 1:420 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3753
Practice Address - Country:US
Practice Address - Phone:508-668-5732
Practice Address - Fax:508-668-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 3674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA64-00057OtherUNITED HEALTH CARE
MAY65218OtherBLUE CROSS
MA37015OtherHARVARD PILGRIM
MA2036864OtherUS HEALTHCARE
MA0374172Medicaid
MA37015OtherFIRST SENIORITY
MA708983OtherSECURE HORIZONS
MA708983OtherTUFTS
MA0374172Medicaid
MA0374172Medicaid