MEDICARE: OFF-SEASON SPORTS & PHYSICAL THERAPY INC

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
1	261QP2000X	Physical Therapy Clinic/Center	18051	MA

General Provider Information

NPI Number	:	1902127913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OFF-SEASON SPORTS & PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	1820 TURNPIKE ST # 200
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6327
Country	:	US
Telephone Number	:	978-688-6181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 OSGOOD ST STE 2085
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-1048
Country	:	US
Telephone Number	:	978-688-6181
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAWRENCE BOURDEAU
Credential	:	DPT, ATC/L, CSCS
Telephone Number	:	413-335-2925

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	09/29/2023

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