Healthcare Provider Details

I. General information

NPI: 1699179606
Provider Name (Legal Business Name): NEIGHBORHOOD PHYSICAL THERAPY 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 WESTFORD ST
LOWELL MA
01851-2519
US

IV. Provider business mailing address

337 WESTFORD ST
LOWELL MA
01851-2519
US

V. Phone/Fax

Practice location:
  • Phone: 978-455-4320
  • Fax: 978-455-4325
Mailing address:
  • Phone: 978-455-4320
  • Fax: 978-455-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number864
License Number StateMA

VIII. Authorized Official

Name: MR. EDWARD SEGEL
Title or Position: COMPLIANCE OFFICER
Credential: PT
Phone: 617-461-8277