Provider Demographics
NPI:1952064396
Name:WITHIN REACH MOBILE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WITHIN REACH MOBILE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. HILAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-803-3015
Mailing Address - Street 1:200F MAIN ST # 170
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1619
Mailing Address - Country:US
Mailing Address - Phone:617-803-3015
Mailing Address - Fax:
Practice Address - Street 1:46 MORGAN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-1239
Practice Address - Country:US
Practice Address - Phone:617-803-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1952372625OtherNPI TYPE 1