Healthcare Provider Details

I. General information

NPI: 1972563344
Provider Name (Legal Business Name): MICHAEL JAMES SOMMERS LATC , PTA, PES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 CRANBERRY HWY
EAST WAREHAM MA
02538-4840
US

IV. Provider business mailing address

12 LADY SLIPPER TRL
ROCHESTER MA
02770-2132
US

V. Phone/Fax

Practice location:
  • Phone: 508-759-5411
  • Fax:
Mailing address:
  • Phone: 508-763-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3778
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1006
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: