Provider Demographics
NPI:1659175404
Name:FOREVER YOUNG PHYSICAL THERAPY AND WELLNESS, LLC
Entity type:Organization
Organization Name:FOREVER YOUNG PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTRESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, LMT
Authorized Official - Phone:857-206-0914
Mailing Address - Street 1:67 EDWARD KELLEHER DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3178
Mailing Address - Country:US
Mailing Address - Phone:857-206-0914
Mailing Address - Fax:
Practice Address - Street 1:67 EDWARD KELLEHER DR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3178
Practice Address - Country:US
Practice Address - Phone:857-206-0914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy