Provider Demographics
NPI:1760185805
Name:VITAL REHAB PHYSICAL THERAPY
Entity Type:Organization
Organization Name:VITAL REHAB PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSERVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:781-290-7430
Mailing Address - Street 1:1373 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2627
Mailing Address - Country:US
Mailing Address - Phone:781-290-7430
Mailing Address - Fax:
Practice Address - Street 1:1373 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2627
Practice Address - Country:US
Practice Address - Phone:781-290-7430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITAL REHAB PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy