Provider Demographics
NPI:1457875775
Name:BREMEN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BREMEN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SANQUINTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-602-3248
Mailing Address - Street 1:464 BREMEN ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1430
Mailing Address - Country:US
Mailing Address - Phone:617-418-5488
Mailing Address - Fax:617-874-8560
Practice Address - Street 1:179 WASHINGTON AVE UNIT A
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-4235
Practice Address - Country:US
Practice Address - Phone:617-446-0832
Practice Address - Fax:617-466-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268756261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy