Provider Demographics
NPI:1487664967
Name:WESTERN MASS. PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:WESTERN MASS. PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-443-4246
Mailing Address - Street 1:290 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4751
Mailing Address - Country:US
Mailing Address - Phone:413-443-4246
Mailing Address - Fax:413-443-0737
Practice Address - Street 1:290 1ST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4751
Practice Address - Country:US
Practice Address - Phone:413-443-4246
Practice Address - Fax:413-443-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65606OtherBC/BS
MA9759441Medicaid
MAPT0003Medicare ID - Type Unspecified