Healthcare Provider Details

I. General information

NPI: 1275644270
Provider Name (Legal Business Name): WORCESTER PHYSICAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GLENNIE ST
WORCESTER MA
01605-3917
US

IV. Provider business mailing address

30 GLENNIE ST
WORCESTER MA
01605-3917
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-8740
  • Fax: 508-752-3716
Mailing address:
  • Phone: 508-791-8740
  • Fax: 508-752-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY LEDOUX
Title or Position: PRACTICE MANAGER
Credential:
Phone: 508-791-8740