Provider Demographics
NPI:1588678312
Name:PRECISION PHYSICAL THERAPY & SPORTS MEDICINE
Entity Type:Organization
Organization Name:PRECISION PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:X
Authorized Official - Last Name:VISOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-395-7333
Mailing Address - Street 1:5 HIGH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3860
Mailing Address - Country:US
Mailing Address - Phone:781-395-7333
Mailing Address - Fax:781-395-7331
Practice Address - Street 1:5 HIGH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3860
Practice Address - Country:US
Practice Address - Phone:781-395-7333
Practice Address - Fax:781-395-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154142081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA698184OtherTUFTS