Provider Demographics
NPI:1669898714
Name:CRITERION
Entity type:Organization
Organization Name:CRITERION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODHILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-632-4423
Mailing Address - Street 1:31 LAKE ST
Mailing Address - Street 2:180
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3879
Mailing Address - Country:US
Mailing Address - Phone:978-632-4432
Mailing Address - Fax:978-632-6022
Practice Address - Street 1:15 MANNING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:MA
Practice Address - Zip Code:01522-1570
Practice Address - Country:US
Practice Address - Phone:508-825-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MA5211253Z00000X, 302F00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty