Basic Information
| Provider Information | |||||||||
| NPI: | 1275644270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WORCESTER PHYSICAL THERAPY SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 GLENNIE ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016053917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087918740 | ||||||||
| FaxNumber: | 5087523716 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 GLENNIE ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016053917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087918740 | ||||||||
| FaxNumber: | 5087523716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEDOUX | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5087918740 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 328820 | 01 | MA | CIGNA | OTHER | 626330 | 01 | MA | HARVARD PILGRIM | OTHER | 64029 | 01 | MA | AETNA | OTHER | 712003 | 01 | MA | TUFTS | OTHER | 1275644270 | 01 | MA | FALLON | OTHER | 1275644270 | 01 | MA | GREAT WEST | OTHER | 9750983 | 05 | MA | MEDICAID | Y61038 | 01 | MA | BLUE CROSS | OTHER | 981075 | 01 | MA | NETWORK HEALTH | OTHER |