Provider Demographics
NPI:1770771446
Name:PERSONALIZED PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PERSONALIZED PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:COFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-384-0105
Mailing Address - Street 1:69 HARVARD LN
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1006
Mailing Address - Country:US
Mailing Address - Phone:508-384-0105
Mailing Address - Fax:
Practice Address - Street 1:69 HARVARD LN
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1006
Practice Address - Country:US
Practice Address - Phone:508-384-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15440261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy