Provider Demographics
NPI:1356404685
Name:AGS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:AGS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:STAMATOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-923-8284
Mailing Address - Street 1:372 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472
Mailing Address - Country:US
Mailing Address - Phone:617-923-8284
Mailing Address - Fax:617-926-6678
Practice Address - Street 1:372 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-923-8284
Practice Address - Fax:617-926-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA.0389153Medicaid
MAV65625OtherBCBS
6811865OtherUNITED HEALTH CARE
MAAA27712OtherHARVARD HC
MAAA27712OtherHARVARD HC