Provider Demographics
NPI:1396083671
Name:GREATER BOSTON FAMILY PHYSICAL THERAPY
Entity type:Organization
Organization Name:GREATER BOSTON FAMILY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAM JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-365-1876
Mailing Address - Street 1:83 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4157
Mailing Address - Country:US
Mailing Address - Phone:781-365-1876
Mailing Address - Fax:781-365-1752
Practice Address - Street 1:83 CAMBRIDGE ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4157
Practice Address - Country:US
Practice Address - Phone:781-365-1876
Practice Address - Fax:781-365-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty