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General NPI Number Information
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NPI Number | 1700561651
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Entity Type | Individual
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Provider Name | BENJAMIN DAVID PURTELL DPT
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Gender | Male
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 101 BROADWAY RD STE 17
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City | DRACUT
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State | MA
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Zip | 01826-4069
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Country | US
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Telephone | 978-881-7698
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Fax |
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Provider Business Mailing Address
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Address Line | 20 2ND AVE APT 418
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City | BURLINGTON
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State | MA
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Zip | 01803-4460
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Country | US
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Telephone | 978-500-8595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 26863
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License Number State | MA
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