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NPI Code Detail

MEDICARE: GREENDALE PHYSICAL THERAPY, LLC

MEDICARE: GREENDALE PHYSICAL THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist15249MA

General Provider Information

NPI Number : 1053316182
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREENDALE PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : 280 BOSTON TPKE
Second Line :
City : SHREWSBURY
State : MA
Zip : 01545-2640
Country : US
Telephone Number : 508-853-4590
Fax Number : 949-756-4811
Provider Business Practice Location Address
First Line : 280 BOSTON TPKE
Second Line :
City : SHREWSBURY
State : MA
Zip : 01545-2640
Country : US
Telephone Number : 508-753-7780
Fax Number : 508-753-7719
Authorized Official
Title or Position : BILLING MANAGER
Name : MS. SAMANTHA ROSE IGNASIAK
Credential :
Telephone Number : 508-853-4590
Provider Enumeration Date : 06/15/2005
Last Update Date : 08/12/2015

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Directions to “GREENDALE PHYSICAL THERAPY, LLC ” Practice Location

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