Healthcare Provider Details

I. General information

NPI: 1720162258
Provider Name (Legal Business Name): FAST TRACK PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 MIDDLESEX ST SUITE 3
LOWELL MA
01851-1352
US

IV. Provider business mailing address

1126 MIDDLESEX ST SUITE 3
LOWELL MA
01851-1352
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-4445
  • Fax: 978-459-7555
Mailing address:
  • Phone: 978-459-4445
  • Fax: 978-459-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16296
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5232
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7655
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8176
License Number StateMA

VIII. Authorized Official

Name: MATTHEW J. KLAYS
Title or Position: OWNER
Credential:
Phone: 978-459-4445