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General NPI Number Information
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NPI Number | 1427202712
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Entity Type | Organization
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Legal Business Name | SOSPT, INC.
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 148 LINDEN ST STE B-8
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City | WELLESLEY
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State | MA
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Zip | 02482-7900
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Country | US
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Telephone | 781-263-9977
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Fax |
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Provider Business Mailing Address
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Address Line | 148 LINDEN ST STE B-8
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City | WELLESLEY
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State | MA
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Zip | 02482-7900
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Country | US
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Telephone | 781-263-9977
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY L. FAGERSON
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Credential | PT, DPT, MS
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Telephone | 781-263-9977
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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 | 8253
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License Number State | MA
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