Provider Demographics
NPI:1528218633
Name:EXERCISE RX PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EXERCISE RX PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BENSON
Authorized Official - Last Name:MCMANAMA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:781-986-0990
Mailing Address - Street 1:15 PACELLA PARK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1700
Mailing Address - Country:US
Mailing Address - Phone:781-986-0990
Mailing Address - Fax:
Practice Address - Street 1:15 PACELLA PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-1700
Practice Address - Country:US
Practice Address - Phone:781-986-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA463261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy