Provider Demographics
NPI:1760762777
Name:SPORTS & WELLNESS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SPORTS & WELLNESS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-528-5723
Mailing Address - Street 1:8 TANGLEWOOD RD
Mailing Address - Street 2:SPORTS & WELLNESS PT
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-5023
Mailing Address - Country:US
Mailing Address - Phone:508-380-6137
Mailing Address - Fax:
Practice Address - Street 1:800 CHESTNUT ST
Practice Address - Street 2:SPORTS & WELLNESS PT
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1271
Practice Address - Country:US
Practice Address - Phone:508-528-5723
Practice Address - Fax:508-528-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty