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General NPI Number Information
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NPI Number | 1558417238
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Entity Type | Organization
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Legal Business Name | MILL BROOK PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 22 MILL ST SUITE 406
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City | ARLINGTON
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State | MA
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Zip | 02476-4784
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Country | US
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Telephone | 781-646-8440
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Fax | 781-643-7542
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Provider Business Mailing Address
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Address Line | 22 MILL ST SUITE 406
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City | ARLINGTON
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State | MA
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Zip | 02476-4784
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Country | US
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Telephone | 781-961-3370
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Fax | 781-767-7531
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Authorized Official
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Title or Position | OWNER
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Name | LENA OLSSON NOONAN
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Credential | PT
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Telephone | 781-961-3370
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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 | 1524
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License Number State | MA
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