Provider Demographics
NPI:1730496696
Name:PHYSICAL THERAPY OF GREATER MATTAPAN PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF GREATER MATTAPAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-783-5783
Mailing Address - Street 1:1613 BLUE HILL AVENUE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2213
Mailing Address - Country:US
Mailing Address - Phone:617-783-5783
Mailing Address - Fax:
Practice Address - Street 1:1613 BLUE HILL AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2123
Practice Address - Country:US
Practice Address - Phone:617-783-5783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy