Provider Demographics
NPI:1518184944
Name:ORTHOSPORT PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ORTHOSPORT PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASSARETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-533-5778
Mailing Address - Street 1:116 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1800
Mailing Address - Country:US
Mailing Address - Phone:508-533-5778
Mailing Address - Fax:508-533-5778
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1800
Practice Address - Country:US
Practice Address - Phone:508-533-5778
Practice Address - Fax:508-533-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA605703OtherHARVARD PILGRIM
MAY61074OtherBLUE CROSS BLUE SHIELD
MA723025OtherTUFTS