Healthcare Provider Details

I. General information

NPI: 1871104471
Provider Name (Legal Business Name): RICHARD SCOTT SHANKS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 SHREWSBURY ST STE 1
BOYLSTON MA
01505-1701
US

IV. Provider business mailing address

81 SHREWSBURY ST STE 1
BOYLSTON MA
01505-1701
US

V. Phone/Fax

Practice location:
  • Phone: 774-614-1322
  • Fax: 774-614-1171
Mailing address:
  • Phone: 774-614-1322
  • Fax: 774-614-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8819
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: