Provider Demographics
NPI:1881712487
Name:NEIGHBORHOOD PHYSICAL THERAPY
Entity type:Organization
Organization Name:NEIGHBORHOOD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-580-4492
Mailing Address - Street 1:138 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4013
Mailing Address - Country:US
Mailing Address - Phone:508-580-4492
Mailing Address - Fax:508-580-4478
Practice Address - Street 1:138 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4013
Practice Address - Country:US
Practice Address - Phone:508-580-4492
Practice Address - Fax:508-580-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA279261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy