Healthcare Provider Details

I. General information

NPI: 1255278149
Provider Name (Legal Business Name): FOGARTY PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 M ST UNIT 165-3
BOSTON MA
02127-6627
US

IV. Provider business mailing address

165 M ST UNIT 165-3
BOSTON MA
02127-6627
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-9794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICK JOHN FOGARTY
Title or Position: OWNER
Credential: PT, DPT
Phone: 401-447-9794