=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578574554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDFIELD ORTHOPEDIC & SPORTS PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 02/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 N MEADOWS RD
-----------------------------------------------------
City | MEDFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02052-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-359-9119
-----------------------------------------------------
Fax | 508-359-9115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 N MEADOWS RD
-----------------------------------------------------
City | MEDFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02052-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-359-9119
-----------------------------------------------------
Fax | 508-359-9115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | BARBARA C SPILLANE
-----------------------------------------------------
Credential | PT, ATC
-----------------------------------------------------
Telephone | 508-359-9119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 292
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------