Basic Information
| Provider Information | |||||||||
| NPI: | 1760762777 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPORTS & WELLNESS PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 TANGLEWOOD RD | ||||||||
| Address2: | SPORTS & WELLNESS PT | ||||||||
| City: | PLAINVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027625023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083806137 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 CHESTNUT ST | ||||||||
| Address2: | SPORTS & WELLNESS PT | ||||||||
| City: | FRANKLIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020381271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085285723 | ||||||||
| FaxNumber: | 5085285729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2011 | ||||||||
| LastUpdateDate: | 04/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOPKINS | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5085285723 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8093 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.