Provider Demographics
NPI:1881022598
Name:NEWBURYPORT WELLNESS, LLC
Entity Type:Organization
Organization Name:NEWBURYPORT WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERVIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-716-4007
Mailing Address - Street 1:11 DREW ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-6202
Mailing Address - Country:US
Mailing Address - Phone:860-716-4007
Mailing Address - Fax:
Practice Address - Street 1:11 DREW ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-6202
Practice Address - Country:US
Practice Address - Phone:860-716-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty