Provider Demographics
NPI:1649242884
Name:PERFORMING ARTS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PERFORMING ARTS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-277-1500
Mailing Address - Street 1:2 MAYFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890
Mailing Address - Country:US
Mailing Address - Phone:617-277-1500
Mailing Address - Fax:617-277-1503
Practice Address - Street 1:1093 BEACON ST
Practice Address - Street 2:BASEMENT SUITE
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-277-1500
Practice Address - Fax:617-277-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61406OtherBCBS
MAY61406OtherBCBS