Basic Information
| Provider Information | |||||||||
| NPI: | 1285689927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENBERG | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 BIRCH ST | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017575501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084730862 | ||||||||
| FaxNumber: | 5084733229 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 BIRCH ST | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084730862 | ||||||||
| FaxNumber: | 5084733229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 02/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 15483 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 15483 | 01 | MA | PT | OTHER |