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General NPI Number Information
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NPI Number | 1164705984
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Entity Type | Organization
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Legal Business Name | SIPPICAN PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 354 FRONT ST
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City | MARION
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State | MA
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Zip | 02738-1533
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Country | US
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Telephone | 774-553-5281
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Fax | 774-553-5283
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Provider Business Mailing Address
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Address Line | 354 FRONT ST
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City | MARION
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State | MA
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Zip | 02738-1533
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Country | US
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Telephone | 774-553-5281
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Fax | 774-553-5281
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | JENNIFER MACDONALD
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Credential |
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Telephone | 774-553-5281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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