Healthcare Provider Details

I. General information

NPI: 1649242884
Provider Name (Legal Business Name): PERFORMING ARTS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 BEACON ST BASEMENT SUITE
BROOKLINE MA
02446
US

IV. Provider business mailing address

2 MAYFLOWER RD
WINCHESTER MA
01890
US

V. Phone/Fax

Practice location:
  • Phone: 617-277-1500
  • Fax: 617-277-1503
Mailing address:
  • Phone: 617-277-1500
  • Fax: 617-277-1503

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: REGINA CAMPBELL
Title or Position: PT OWNER
Credential:
Phone: 617-277-1500