Healthcare Provider Details

I. General information

NPI: 1558417238
Provider Name (Legal Business Name): MILL BROOK PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST SUITE 406
ARLINGTON MA
02476-4784
US

IV. Provider business mailing address

22 MILL ST SUITE 406
ARLINGTON MA
02476-4784
US

V. Phone/Fax

Practice location:
  • Phone: 781-646-8440
  • Fax: 781-643-7542
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-767-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1524
License Number StateMA

VIII. Authorized Official

Name: LENA OLSSON NOONAN
Title or Position: OWNER
Credential: PT
Phone: 781-961-3370