Provider Demographics
NPI:1700056850
Name:RAQUEL K. PERLIS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:RAQUEL K. PERLIS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PERLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-237-9006
Mailing Address - Street 1:332 WASHINGTON ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6219
Mailing Address - Country:US
Mailing Address - Phone:781-237-9006
Mailing Address - Fax:781-237-4723
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:SUITE 315
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-6219
Practice Address - Country:US
Practice Address - Phone:781-237-9006
Practice Address - Fax:781-237-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT82225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT005001Medicare PIN