Provider Demographics
NPI:1962837799
Name:VILLAGE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:VILLAGE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-542-9888
Mailing Address - Street 1:203 POPES IS
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-7232
Mailing Address - Country:US
Mailing Address - Phone:508-542-9888
Mailing Address - Fax:508-991-5505
Practice Address - Street 1:203 POPES IS
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7232
Practice Address - Country:US
Practice Address - Phone:508-542-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10763261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy