Provider Demographics
NPI:1568005627
Name:PRESERVATION PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:PRESERVATION PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-505-8446
Mailing Address - Street 1:4 WETHERSFIELD RD STE 8
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1770
Mailing Address - Country:US
Mailing Address - Phone:508-653-6000
Mailing Address - Fax:508-653-5555
Practice Address - Street 1:4 WETHERSFIELD RD STE 8
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1770
Practice Address - Country:US
Practice Address - Phone:508-653-6000
Practice Address - Fax:508-653-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty