Provider Demographics
NPI:1558883371
Name:PADME PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PADME PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLOY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-355-6657
Mailing Address - Street 1:644 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1857
Mailing Address - Country:US
Mailing Address - Phone:617-355-6657
Mailing Address - Fax:781-314-8163
Practice Address - Street 1:644 HIGH ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1857
Practice Address - Country:US
Practice Address - Phone:617-355-6657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy