Provider Demographics
NPI:1760925929
Name:AT HOME PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:AT HOME PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-306-6519
Mailing Address - Street 1:30 PLAYSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:63 PAGE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1534
Practice Address - Country:US
Practice Address - Phone:617-306-6519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty