Provider Demographics
NPI:1659465649
Name:NEEDHAM PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:NEEDHAM PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-444-0345
Mailing Address - Street 1:10 OAK ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2409
Mailing Address - Country:US
Mailing Address - Phone:781-444-0345
Mailing Address - Fax:781-444-6105
Practice Address - Street 1:10 OAK ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2409
Practice Address - Country:US
Practice Address - Phone:781-444-0345
Practice Address - Fax:781-444-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA605849OtherHARVARD PILGRIM HEALTH CA
MA9760652Medicaid
MA0000Y65620OtherBLUE CROSS BLUE SHIELD
MA9760652Medicaid