Provider Demographics
NPI:1932209251
Name:SHAFA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SHAFA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATEMEH
Authorized Official - Middle Name:MEHRY
Authorized Official - Last Name:BEHBAKHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-391-5151
Mailing Address - Street 1:196 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:196 BOSTON AVE
Practice Address - Street 2:SUITE 2200
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4236
Practice Address - Country:US
Practice Address - Phone:781-391-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1039261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9754351Medicaid
MA9754351Medicaid