Healthcare Provider Details

I. General information

NPI: 1538625710
Provider Name (Legal Business Name): DOWNTOWN PHYSICAL THERAPY AND REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LEWIS WHARF
BOSTON MA
02110-3926
US

IV. Provider business mailing address

125 LEWIS WHARF
BOSTON MA
02110-3926
US

V. Phone/Fax

Practice location:
  • Phone: 617-523-2766
  • Fax: 617-523-3063
Mailing address:
  • Phone: 617-523-2766
  • Fax: 617-523-3063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DIEM HA
Title or Position: OWNER
Credential:
Phone: 617-523-2766