Healthcare Provider Details

I. General information

NPI: 1497769483
Provider Name (Legal Business Name): JUMP START PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 H F BROWN WAY
NATICK MA
01760-3889
US

IV. Provider business mailing address

1 H F BROWN WAY
NATICK MA
01760-3889
US

V. Phone/Fax

Practice location:
  • Phone: 508-647-1633
  • Fax: 508-647-1634
Mailing address:
  • Phone: 508-647-1633
  • Fax: 508-647-1634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number11437
License Number StateMA

VIII. Authorized Official

Name: DANIEL M CONNORS
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: PT, MS, CSCS, USAW
Phone: 508-647-1633