Healthcare Provider Details

I. General information

NPI: 1912099961
Provider Name (Legal Business Name): SPORTS MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306A HIGH STREET
GREENFIELD MA
01301
US

IV. Provider business mailing address

306A HIGH STREET
GREENFIELD MA
01301
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-3379
  • Fax: 413-772-2705
Mailing address:
  • Phone: 413-773-3379
  • Fax: 413-772-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: REID JEFFRIES ANDERSON
Title or Position: OWNER / TREASURER
Credential: P.T.
Phone: 413-773-3379