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General NPI Number Information
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NPI Number | 1902965205
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL FITNESS AND PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 50 OLIVER ST SUITE W-2B
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City | NORTH EASTON
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State | MA
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Zip | 02356-1446
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Country | US
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Telephone | 508-682-0186
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Fax |
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Provider Business Mailing Address
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Address Line | 50 OLIVER ST SUITE W-2B
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City | NORTH EASTON
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State | MA
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Zip | 02356-1446
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Country | US
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Telephone | 508-682-0186
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH COE ANESTAM
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Credential | P.T.
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Telephone | 508-682-0186
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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 | 13125
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License Number State | MA
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