Provider Demographics
NPI:1689863912
Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY INC
Other - Org Name:PHYSICAL THERAPY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADM. ASST
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-584-0800
Mailing Address - Street 1:320 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5323
Mailing Address - Country:US
Mailing Address - Phone:508-584-0800
Mailing Address - Fax:508-583-3454
Practice Address - Street 1:320 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5323
Practice Address - Country:US
Practice Address - Phone:508-584-0800
Practice Address - Fax:508-583-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9729607Medicaid
MAPT0036Medicare PIN