Basic Information
| Provider Information | |||||||||
| NPI: | 1780196980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERSONAL BEST PHYSICAL THERAPY OF NORFOLK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 HOLBROOK ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020561849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7745650796 | ||||||||
| FaxNumber: | 7745658346 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 HOLBROOK ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020561849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7745650796 | ||||||||
| FaxNumber: | 7745658346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2017 | ||||||||
| LastUpdateDate: | 10/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | MARTINIS | ||||||||
| AuthorizedOfficialFirstName: | KYLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTIAL OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7745650796 | ||||||||
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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 | 22262 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.