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General NPI Number Information
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NPI Number | 1871907618
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 214 N MAIN ST SUITE 207
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City | NATICK
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State | MA
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Zip | 01760-1131
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Country | US
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Telephone | 508-653-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 214 N MAIN ST SUITE 207
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City | NATICK
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State | MA
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Zip | 01760-1131
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Country | US
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Telephone | 508-653-2001
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. URSULA FLAHERTY
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Credential | PT
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Telephone | 508-653-2001
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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 | 7326
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License Number State | MA
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