Provider Demographics
NPI:1720162258
Name:FAST TRACK PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:FAST TRACK PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-459-4445
Mailing Address - Street 1:1126 MIDDLESEX ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1352
Mailing Address - Country:US
Mailing Address - Phone:978-459-4445
Mailing Address - Fax:978-459-7555
Practice Address - Street 1:1126 MIDDLESEX ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1352
Practice Address - Country:US
Practice Address - Phone:978-459-4445
Practice Address - Fax:978-459-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16296225100000X
MA5232225100000X
MA7655225200000X
MA8176225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9736280OtherMASSHEALTH
MA9736280OtherMASSHEALTH