Provider Demographics
NPI:1356982920
Name:PHOENIX THERAPY SERVICE
Entity type:Organization
Organization Name:PHOENIX THERAPY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:H
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-308-7373
Mailing Address - Street 1:43 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1835
Mailing Address - Country:US
Mailing Address - Phone:617-308-7373
Mailing Address - Fax:
Practice Address - Street 1:43 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1835
Practice Address - Country:US
Practice Address - Phone:617-308-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty