Provider Demographics
NPI:1649410838
Name:HOLLISTON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HOLLISTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCYQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-429-1634
Mailing Address - Street 1:46 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1580
Mailing Address - Country:US
Mailing Address - Phone:508-429-1634
Mailing Address - Fax:508-429-1973
Practice Address - Street 1:46 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1580
Practice Address - Country:US
Practice Address - Phone:508-429-1634
Practice Address - Fax:508-429-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty