Healthcare Provider Details

I. General information

NPI: 1881903615
Provider Name (Legal Business Name): ORTHOPEDIC & SPORTS PHYSICAL THERAPY OF CAPE COD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 ROUTE 137
HARWICH MA
02645-1316
US

IV. Provider business mailing address

172 ROUTE 137
HARWICH MA
02645-1316
US

V. Phone/Fax

Practice location:
  • Phone: 774-237-0832
  • Fax: 774-408-7164
Mailing address:
  • Phone: 774-237-0832
  • Fax: 774-408-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8810
License Number StateMA

VIII. Authorized Official

Name: RICHARD F QUALTER
Title or Position: PHYSICAL THERAPIST
Credential: MSPT
Phone: 774-237-0832