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General NPI Number Information
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NPI Number | 1538202932
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC AND SPORTS MEDICINE SPECIALISTS, INC.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 231 SUTTON ST SUITE 1C
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City | NORTH ANDOVER
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State | MA
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Zip | 01845
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Country | US
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Telephone | 978-685-8059
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Fax | 978-685-6421
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Provider Business Mailing Address
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Address Line | 231 SUTTON ST SUITE 1C
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-1620
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Country | US
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Telephone | 978-685-8059
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Fax | 978-685-6421
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD DOUGLAS MOULTON
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Credential | P.T.
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Telephone | 978-685-8059
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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 | 186
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License Number State | MA
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