Healthcare Provider Details

I. General information

NPI: 1821081217
Provider Name (Legal Business Name): METROPOLITAN WEST PHYSICAL THERAPY AND SPORTS MEDICINE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DAMONMILL SQUARE
CONCORD MA
01742
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DEPT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-9996
  • Fax: 978-371-2516
Mailing address:
  • Phone: 717-975-4503
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL E. TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-975-4503