Provider Demographics
NPI:1598766198
Name:BLACKSTONE VALLEY PHYSICAL THERAPY SERVICES INC
Entity Type:Organization
Organization Name:BLACKSTONE VALLEY PHYSICAL THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-234-7544
Mailing Address - Street 1:670 LINWOOD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-2068
Mailing Address - Country:US
Mailing Address - Phone:508-234-7544
Mailing Address - Fax:508-234-8002
Practice Address - Street 1:670 LINWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-2068
Practice Address - Country:US
Practice Address - Phone:508-234-7544
Practice Address - Fax:508-234-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA626572OtherHARVARD PILGRIM
MA64-00083OtherUNITED HEALTHCARE
MA60156OtherFIRST HEALTH
MA603778OtherTUFTS
MAY65612OtherBLUE CROSS BLUE SHIELD
MAY65612OtherBLUE CROSS BLUE SHIELD
MA64-00083OtherUNITED HEALTHCARE