Healthcare Provider Details

I. General information

NPI: 1871657163
Provider Name (Legal Business Name): MOUNT HOPE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 GRAND ARMY HWY
SWANSEA MA
02777-3906
US

IV. Provider business mailing address

1738 GRAND ARMY HIGHWAY
SWANSEA MA
02777
US

V. Phone/Fax

Practice location:
  • Phone: 508-379-0090
  • Fax: 508-379-6050
Mailing address:
  • Phone: 508-379-0090
  • Fax: 508-379-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number338
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8384
License Number StateMA

VIII. Authorized Official

Name: MR. MATTHEW J NEVES II
Title or Position: PRESIDENT
Credential: PTA
Phone: 508-379-0090