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General NPI Number Information
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NPI Number | 1356404685
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Entity Type | Organization
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Legal Business Name | AGS PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 372 MAIN STREET
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City | WATERTOWN
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State | MA
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Zip | 02472
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Country | US
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Telephone | 617-923-8284
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Fax | 617-926-6678
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Provider Business Mailing Address
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Address Line | 372 MAIN STREET
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City | WATERTOWN
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State | MA
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Zip | 02472
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Country | US
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Telephone | 617-923-8284
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Fax | 617-926-6678
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. GEORGE S STAMATOPOULOS
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Credential | PT
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Telephone | 617-923-8284
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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 | 5194
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License Number State | MA
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