Basic Information
| Provider Information | |||||||||
| NPI: | 1598905358 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT VERZONE PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 PADDINGTON WAY | ||||||||
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| City: | PLYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023604947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087472289 | ||||||||
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| Practice Location | |||||||||
| Address1: | 284 MONPONSETT ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HALIFAX | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023381430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812932525 | ||||||||
| FaxNumber: | 7812932828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 02/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | VERZONE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | FRANCIS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7812932525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2914 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 499223 | 01 | MA | TUFTS HEALTH PLAN | OTHER | AA142725 | 01 | MA | HARVARD PILGRIM HEALTHCARE | OTHER | 70010000Y61555 | 01 | MA | BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS (HMO) | OTHER |