Healthcare Provider Details

I. General information

NPI: 1881731701
Provider Name (Legal Business Name): TYNGSBOROUGH PHYSICAL THERAPY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MIDDLESEX RD
TYNGSBORO MA
01879-1028
US

IV. Provider business mailing address

315 MIDDLESEX RD
TYNGSBORO MA
01879-1028
US

V. Phone/Fax

Practice location:
  • Phone: 978-649-2592
  • Fax: 978-649-4620
Mailing address:
  • Phone: 978-649-2592
  • Fax: 978-649-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4948
License Number StateMA

VIII. Authorized Official

Name: MRS. SUSAN C ABIS
Title or Position: OWNER
Credential: PT
Phone: 978-649-2592