Provider Demographics
NPI:1841348505
Name:PATRIOT ALL PRO PHYSICAL THERAPY CENTERS
Entity type:Organization
Organization Name:PATRIOT ALL PRO PHYSICAL THERAPY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TIPPETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-897-0056
Mailing Address - Street 1:348 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1197
Mailing Address - Country:US
Mailing Address - Phone:508-897-0056
Mailing Address - Fax:508-584-5630
Practice Address - Street 1:348 N PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1197
Practice Address - Country:US
Practice Address - Phone:508-897-0056
Practice Address - Fax:508-584-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61278OtherBLUE CROSS BLUE SHIELD OF MA
MA24063OtherBMC HEALTH NET
MA626334OtherHARVARD PILGRIM HEALTHCARE
MA695105OtherTUFTS HEALTH PLAN
MA9720430Medicaid
MA0033304OtherNEIGHBORHOOD HEALTH PLAN
MA9720430OtherMASS HEALTH
MA968175OtherNETWORK HEALTH
MAPAPT0123Medicare PIN