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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier328820
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA
# 2
Identifier626330
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerHARVARD PILGRIM
# 3
Identifier64029
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerAETNA
# 4
Identifier712003
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS
# 5
Identifier1275644270
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerFALLON
# 6
Identifier1275644270
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerGREAT WEST
# 7
Identifier9750983
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 8
IdentifierY61038
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS
# 9
Identifier981075
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNETWORK HEALTH

VIII. Authorized Official

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