Provider Demographics
NPI:1649800442
Name:OCEANSIDE PHYSICAL THERAPY AND WELLNESS CENTER INC.
Entity type:Organization
Organization Name:OCEANSIDE PHYSICAL THERAPY AND WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MACLAUCHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-549-7921
Mailing Address - Street 1:3 RED FOX RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1569
Mailing Address - Country:US
Mailing Address - Phone:617-549-7921
Mailing Address - Fax:
Practice Address - Street 1:364 OCEAN AVE STE C-102
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-2629
Practice Address - Country:US
Practice Address - Phone:617-549-7921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty