Healthcare Provider Details

I. General information

NPI: 1558608976
Provider Name (Legal Business Name): EAST MAIN PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MAIN ST
FALL RIVER MA
02720-2150
US

IV. Provider business mailing address

150 N MAIN ST
FALL RIVER MA
02720-2150
US

V. Phone/Fax

Practice location:
  • Phone: 508-646-1722
  • Fax: 508-675-3064
Mailing address:
  • Phone: 508-646-1722
  • Fax: 508-675-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number419
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. TRACY G. DIAS
Title or Position: MANAGER
Credential:
Phone: 508-646-1722