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General NPI Number Information
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NPI Number | 1578956389
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Entity Type | Organization
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Legal Business Name | WHITECAP PERFORMANCE LLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 35 POND PARK RD SUITE 1
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City | HINGHAM
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State | MA
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Zip | 02043-4350
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Country | US
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Telephone | 781-749-3833
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Fax | 781-749-3848
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Provider Business Mailing Address
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Address Line | 35 POND PARK RD SUITE 1
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City | HINGHAM
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State | MA
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Zip | 02043-4350
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Country | US
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Telephone | 781-749-3833
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Fax | 781-749-3848
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Authorized Official
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Title or Position | DIRECTOR OF PHYSICAL THERAPY
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Name | DWIGHT HARTMAN
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Credential | MSPT
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Telephone | 781-749-3833
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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 | 904
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License Number State | MA
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