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General NPI Number Information
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NPI Number | 1154777381
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Entity Type | Organization
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Legal Business Name | PT FOR LIFE LLC
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 33 UNION ST
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City | MANCHESTER
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State | MA
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Zip | 01944-1555
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Country | US
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Telephone | 617-939-6794
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Fax |
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Provider Business Mailing Address
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Address Line | 13 NORWOOD AVE
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City | MANCHESTER
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State | MA
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Zip | 01944-1507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | JULIE CROCKER
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Credential | DPT
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Telephone | 617-939-6794
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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 | 15884
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License Number State | MA
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