Provider Demographics
NPI:1780368605
Name:PREMIER PERFORMANCE PHYSICAL THERAPY AND SPORTS MEDICINE, L.L.C.
Entity type:Organization
Organization Name:PREMIER PERFORMANCE PHYSICAL THERAPY AND SPORTS MEDICINE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:617-932-1027
Mailing Address - Street 1:241 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1049
Mailing Address - Country:US
Mailing Address - Phone:978-500-3003
Mailing Address - Fax:
Practice Address - Street 1:50 BEHARRELL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1749
Practice Address - Country:US
Practice Address - Phone:617-932-1027
Practice Address - Fax:617-932-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty