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General NPI Number Information
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NPI Number | 1255572822
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Entity Type | Organization
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Legal Business Name | LIVE FREE PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 493 MAIN ST SUITE 2F
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City | GROTON
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State | MA
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Zip | 01450-4254
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Country | US
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Telephone | 617-835-7455
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Fax |
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Provider Business Mailing Address
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Address Line | 20 HOYLE ST UNIT 3
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City | NORWOOD
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State | MA
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Zip | 02062-3227
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Country | US
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Telephone | 617-835-7455
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CHRISTINE FELICE AWDYCKI
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Credential | MSPT
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Telephone | 617-835-7455
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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 | 15626
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License Number State | MA
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