Provider Demographics
NPI:1760601942
Name:PRO PHYSICAL THERAPY & SPORTSCARE, INC.
Entity Type:Organization
Organization Name:PRO PHYSICAL THERAPY & SPORTSCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:LECLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-336-3121
Mailing Address - Street 1:350 FALL RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5506
Mailing Address - Country:US
Mailing Address - Phone:508-336-3121
Mailing Address - Fax:508-336-3120
Practice Address - Street 1:350 FALL RIVER AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5506
Practice Address - Country:US
Practice Address - Phone:508-336-3121
Practice Address - Fax:508-336-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8100225100000X
RIPT00460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61010OtherBLUE CROSS BLUE SHIELD MA
RI2520-9OtherBLUE CROSS BLUE SHIELD RI
RI402383OtherBLUE CHIP
MA43142951OtherHEALTHCARE VALUE MGMT
RI64-00067OtherUNITED HEALTH
MA608183OtherTUFTS
MA605708OtherHARVARD PILGRIM
102722300OtherDEPT OF LABOR ACS
RIPR35723Medicaid
MAY61010OtherBLUE CROSS BLUE SHIELD MA
RIPR35723Medicaid
=========OtherPRIVATE HEALTHCARE SYSTEM
=========OtherTRICARE