Provider Demographics
NPI:1972553857
Name:TEAMWORK PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:TEAMWORK PHYSICAL THERAPY INC
Other - Org Name:TEAMWORK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:AUDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:BS,PTA
Authorized Official - Phone:617-847-0066
Mailing Address - Street 1:618 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7335
Mailing Address - Country:US
Mailing Address - Phone:617-847-0066
Mailing Address - Fax:617-847-0908
Practice Address - Street 1:618 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7335
Practice Address - Country:US
Practice Address - Phone:617-847-0066
Practice Address - Fax:617-847-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9717625Medicaid
MA9717625Medicaid