Provider Demographics
NPI:1588641807
Name:PRESCRIPTION ORTHOPEDIC AND SPORTS THERAPY
Entity Type:Organization
Organization Name:PRESCRIPTION ORTHOPEDIC AND SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-729-1004
Mailing Address - Street 1:235 CYPRESS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6776
Mailing Address - Country:US
Mailing Address - Phone:617-738-1004
Mailing Address - Fax:617-731-4162
Practice Address - Street 1:235 CYPRESS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6776
Practice Address - Country:US
Practice Address - Phone:617-738-1004
Practice Address - Fax:617-731-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0077Medicare PIN