Provider Demographics
NPI:1578956389
Name:WHITECAP PERFORMANCE LLC
Entity Type:Organization
Organization Name:WHITECAP PERFORMANCE LLC
Other - Org Name:CATZ HINGHAM PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:781-749-3833
Mailing Address - Street 1:35 POND PARK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4350
Mailing Address - Country:US
Mailing Address - Phone:781-749-3833
Mailing Address - Fax:781-749-3848
Practice Address - Street 1:35 POND PARK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4350
Practice Address - Country:US
Practice Address - Phone:781-749-3833
Practice Address - Fax:781-749-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty