Healthcare Provider Details

I. General information

NPI: 1518238609
Provider Name (Legal Business Name): PLEASANT BAY HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 WOODLANDS WAY
BREWSTER MA
02631
US

IV. Provider business mailing address

383 S ORLEANS RD
BREWSTER MA
02631-2870
US

V. Phone/Fax

Practice location:
  • Phone: 508-240-1110
  • Fax:
Mailing address:
  • Phone: 508-240-3500
  • Fax: 508-240-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ROXANNE WEBSTER
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 508-240-3500