Healthcare Provider Details

I. General information

NPI: 1568437895
Provider Name (Legal Business Name): FUNCTION FIRST PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MAIN ST SUITE 12
HYANNIS MA
02601-5100
US

IV. Provider business mailing address

PO BOX 346
WEST BARNSTABLE MA
02668-0346
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-4317
  • Fax: 508-778-4376
Mailing address:
  • Phone: 508-778-4317
  • Fax: 508-778-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number11657
License Number StateMA

VIII. Authorized Official

Name: MR. JAMES HAWLEY JR.
Title or Position: PRESIDENT/OWNER
Credential: PT
Phone: 508-778-4317