Provider Demographics
NPI:1629160411
Name:ANDRES P LAURITS
Entity Type:Organization
Organization Name:ANDRES P LAURITS
Other - Org Name:WAKEFIELD PHYSICAL THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURITS
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:781-246-2266
Mailing Address - Street 1:384 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1986
Mailing Address - Country:US
Mailing Address - Phone:781-246-2266
Mailing Address - Fax:781-246-1098
Practice Address - Street 1:384 LOWELL ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1986
Practice Address - Country:US
Practice Address - Phone:781-246-2266
Practice Address - Fax:781-246-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-16
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
MA0376566Medicaid
MAPT0046Medicare ID - Type Unspecified