Healthcare Provider Details

I. General information

NPI: 1659465649
Provider Name (Legal Business Name): NEEDHAM PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 OAK ST SUITE 2
NEEDHAM MA
02492-2409
US

IV. Provider business mailing address

10 OAK ST SUITE 2
NEEDHAM MA
02492-2409
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-0345
  • Fax: 781-444-6105
Mailing address:
  • Phone: 781-444-0345
  • Fax: 781-444-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DENISE A BACH
Title or Position: PRESIDENT
Credential: PT
Phone: 781-444-0345