Provider Demographics
NPI:1639591126
Name:ELLIOTT PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ELLIOTT PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-688-3332
Mailing Address - Street 1:960 MORRISSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3206
Mailing Address - Country:US
Mailing Address - Phone:617-688-3332
Mailing Address - Fax:
Practice Address - Street 1:960 MORRISSEY BLVD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3206
Practice Address - Country:US
Practice Address - Phone:617-506-7210
Practice Address - Fax:617-506-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty