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General NPI Number Information
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NPI Number | 1497880215
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Entity Type | Organization
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Legal Business Name | PRO REHAB, INC, PC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 03/31/2012
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Provider Practice Location Address
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Address Line | 278 BROADWAY ST
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City | LOWELL
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State | MA
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Zip | 01854-4121
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Country | US
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Telephone | 978-452-6633
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Fax | 978-935-2741
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Provider Business Mailing Address
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Address Line | 278 BROADWAY ST
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City | LOWELL
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State | MA
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Zip | 01854-4121
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Country | US
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Telephone | 978-452-6633
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Fax | 978-935-2741
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Authorized Official
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Title or Position | PHYSICAL THERAPISTPRESIDENT
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Name | DR. GEORGE POTAMITIS
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Credential | PT, DPT, MS
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Telephone | 978-452-6633
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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 | 136
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License Number State | MA
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