Basic Information
| Provider Information | |||||||||
| NPI: | 1134106446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY HEALTH SERVICES, INC | ||||||||
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| OtherOrganizationName: | PHYSICAL THERAPY HEALTH CONNECTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 WASHINGTON ST | ||||||||
| Address2: | STE 462 | ||||||||
| City: | CANTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020214006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818287920 | ||||||||
| FaxNumber: | 7818287951 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 WASHINGTON ST | ||||||||
| Address2: | STE 462 | ||||||||
| City: | CANTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020214006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818287920 | ||||||||
| FaxNumber: | 7818287951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 02/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | MAILHOT | ||||||||
| AuthorizedOfficialFirstName: | KIRSTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7743312620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT0031 | 01 | MA | MEDICARE PTAN | OTHER |