Healthcare Provider Details

I. General information

NPI: 1700056850
Provider Name (Legal Business Name): RAQUEL K. PERLIS PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 WASHINGTON ST SUITE 315
WELLESLEY HILLS MA
02481-6219
US

IV. Provider business mailing address

332 WASHINGTON ST SUITE 315
WELLESLEY HILLS MA
02481-6219
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-9006
  • Fax: 781-237-4723
Mailing address:
  • Phone: 781-237-9006
  • Fax: 781-237-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT82
License Number StateMA

VIII. Authorized Official

Name: MRS. RAQUEL K PERLIS
Title or Position: PRESIDENT
Credential: P.T.
Phone: 781-237-9006