Provider Demographics
NPI:1851930028
Name:CORE PHYSICAL THERAPY & PERFORMANCE, LLC
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY & PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCCHESI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:508-314-6008
Mailing Address - Street 1:53 FARM ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2304
Mailing Address - Country:US
Mailing Address - Phone:508-314-6008
Mailing Address - Fax:
Practice Address - Street 1:11 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4321
Practice Address - Country:US
Practice Address - Phone:508-314-6008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1255755831Medicaid