Provider Demographics
NPI:1750349908
Name:DEMPSEY PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:DEMPSEY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:413-644-0110
Mailing Address - Street 1:777 S MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2140
Mailing Address - Country:US
Mailing Address - Phone:412-644-0110
Mailing Address - Fax:413-644-0112
Practice Address - Street 1:777 S MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2140
Practice Address - Country:US
Practice Address - Phone:412-644-0110
Practice Address - Fax:413-644-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9926261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61421OtherBLUE CROSS OF MA
MANO-PT0314Medicare ID - Type Unspecified