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General NPI Number Information
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NPI Number | 1457875775
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Entity Type | Organization
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Legal Business Name | BREMEN PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 179 WASHINGTON AVE UNIT A
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City | CHELSEA
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State | MA
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Zip | 02150-4235
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Country | US
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Telephone | 617-446-0832
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Fax | 617-466-1400
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Provider Business Mailing Address
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Address Line | 464 BREMEN ST STE 4B
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City | EAST BOSTON
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State | MA
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Zip | 02128-1430
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Country | US
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Telephone | 617-418-5488
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Fax | 617-874-8560
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Authorized Official
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Title or Position | OWNER
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Name | IVAN DAVID SANQUINTIN
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Credential |
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Telephone | 617-602-3248
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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 | 268756
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License Number State | MA
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