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General NPI Number Information
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NPI Number | 1780986539
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Entity Type | Organization
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Legal Business Name | PLYMOUTH REGIONAL REHABILITATION SERVICES LLC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 790 LAKE ST
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City | BRISTOL
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State | NH
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Zip | 03222-4548
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Country | US
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Telephone | 603-744-0275
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Fax | 603-744-9378
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Provider Business Mailing Address
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Address Line | 60 LYME ST
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City | OLD LYME
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State | CT
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Zip | 06371-2332
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Country | US
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Telephone | 860-434-9398
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Fax | 860-434-0739
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Authorized Official
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Title or Position | VP FINANCE
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Name | MICHAEL FORTUNATO
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Credential |
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Telephone | 860-434-9398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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