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General NPI Number Information
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NPI Number | 1134259252
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Entity Type | Organization
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Legal Business Name | SPORTS THERAPY & REHABILITATION CENTER, INC.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 84 HIGHLAND AVE SUITE 201
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City | SALEM
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State | MA
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Zip | 01970-2727
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Country | US
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Telephone | 978-741-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 84 HIGHLAND AVE
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City | SALEM
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State | MA
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Zip | 01970-2727
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Country | US
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Telephone | 978-741-0880
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MR. CHRIS JENSEN
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Credential | PT
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Telephone | 978-741-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 135
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License Number State | MA
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