Provider Demographics
NPI:1205918463
Name:ORTHO SPORT PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ORTHO SPORT PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-588-2800
Mailing Address - Street 1:320 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1626
Mailing Address - Country:US
Mailing Address - Phone:508-588-2800
Mailing Address - Fax:508-588-2881
Practice Address - Street 1:320 W CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1626
Practice Address - Country:US
Practice Address - Phone:508-588-2800
Practice Address - Fax:508-588-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
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
PT0164Medicare PIN