Provider Demographics
NPI:1548417892
Name:ACHATES PHYSICAL THERAPY,LTD
Entity Type:Organization
Organization Name:ACHATES PHYSICAL THERAPY,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-830-0123
Mailing Address - Street 1:225 WATER ST
Mailing Address - Street 2:SUITE A-202
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4060
Mailing Address - Country:US
Mailing Address - Phone:508-830-0123
Mailing Address - Fax:508-830-0234
Practice Address - Street 1:225 WATER ST
Practice Address - Street 2:SUITE A-202
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4060
Practice Address - Country:US
Practice Address - Phone:508-830-0123
Practice Address - Fax:508-830-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA413261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy