Healthcare Provider Details

I. General information

NPI: 1679863922
Provider Name (Legal Business Name): PT4U
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 GREAT RD
BEDFORD MA
01730-2359
US

IV. Provider business mailing address

328 GREAT RD
BEDFORD MA
01730-2359
US

V. Phone/Fax

Practice location:
  • Phone: 781-430-0078
  • Fax: 781-274-1259
Mailing address:
  • Phone: 781-430-0078
  • Fax: 781-274-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number17910
License Number StateMA

VIII. Authorized Official

Name: SHARON A MACEACHRON
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: MSPT
Phone: 781-430-0078