Provider Demographics
NPI:1518410059
Name:WELLBRIDGE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WELLBRIDGE PHYSICAL THERAPY
Other - Org Name:WELLBRIDGE PHYSICAL THERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHURSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:617-965-8070
Mailing Address - Street 1:29 CRAFTS ST STE 570
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1282
Mailing Address - Country:US
Mailing Address - Phone:617-965-8070
Mailing Address - Fax:617-965-8071
Practice Address - Street 1:29 CRAFTS ST STE 570
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1282
Practice Address - Country:US
Practice Address - Phone:617-965-8070
Practice Address - Fax:617-965-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0032695Medicare UPIN