Provider Demographics
NPI:1760549356
Name:NORWELL PHYSICAL THERAPY & SPORTS REHAB, INC.
Entity Type:Organization
Organization Name:NORWELL PHYSICAL THERAPY & SPORTS REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-659-7937
Mailing Address - Street 1:306 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1704
Mailing Address - Country:US
Mailing Address - Phone:781-659-7937
Mailing Address - Fax:
Practice Address - Street 1:306 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1704
Practice Address - Country:US
Practice Address - Phone:781-659-7937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4900261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65978Medicare ID - Type Unspecified