Provider Demographics
NPI:1619146172
Name:SAUGUS PHYSICAL THERAPY CORP
Entity Type:Organization
Organization Name:SAUGUS PHYSICAL THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-233-2016
Mailing Address - Street 1:194 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2107
Mailing Address - Country:US
Mailing Address - Phone:781-231-3475
Mailing Address - Fax:781-233-0959
Practice Address - Street 1:194 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-2107
Practice Address - Country:US
Practice Address - Phone:781-231-3475
Practice Address - Fax:781-233-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005310OtherMEDICARE PTAN