Basic Information
| Provider Information | |||||||||
| NPI: | 1831594282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOTAL REHAB AND FITNESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 179 BEAR HILL RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024511063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818959500 | ||||||||
| FaxNumber: | 7818954800 | ||||||||
| Practice Location | |||||||||
| Address1: | 179 BEAR HILL RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024511063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818959500 | ||||||||
| FaxNumber: | 7818954800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2014 | ||||||||
| LastUpdateDate: | 02/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | MARMAROU | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6092025353 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 225XN1300X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 2251X0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.