Provider Demographics
NPI:1245528074
Name:BROCKTON PHYSICAL THERAPY & REHABILITATION, INC.
Entity type:Organization
Organization Name:BROCKTON PHYSICAL THERAPY & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LAPUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-588-2239
Mailing Address - Street 1:340 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3236
Mailing Address - Country:US
Mailing Address - Phone:508-588-2239
Mailing Address - Fax:508-587-0411
Practice Address - Street 1:340 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3236
Practice Address - Country:US
Practice Address - Phone:508-588-2239
Practice Address - Fax:508-587-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty