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General NPI Number Information
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NPI Number | 1689228496
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Entity Type | Organization
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Legal Business Name | CCBF, LLC
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 11 PLEASANT LAKE AVE
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City | HARWICH
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State | MA
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Zip | 02645-2661
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Country | US
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Telephone | 508-205-9366
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Fax |
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Provider Business Mailing Address
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Address Line | 27 RENOIR DR
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City | OSTERVILLE
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State | MA
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Zip | 02655-1253
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Country | US
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Telephone | 508-205-9366
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE SOARES
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Credential | PT, DPT
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Telephone | 508-205-9366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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