Provider Demographics
NPI:1255740056
Name:A-GAME PHYSICAL THERAPY AND REHABILITATION CORP.
Entity type:Organization
Organization Name:A-GAME PHYSICAL THERAPY AND REHABILITATION CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAKOZOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:857-445-3773
Mailing Address - Street 1:556 CAMBRIDGE ST
Mailing Address - Street 2:101
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2496
Mailing Address - Country:US
Mailing Address - Phone:857-445-3773
Mailing Address - Fax:617-916-5733
Practice Address - Street 1:556 CAMBRIDGE ST
Practice Address - Street 2:101
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2496
Practice Address - Country:US
Practice Address - Phone:857-445-3773
Practice Address - Fax:617-916-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17858261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy