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General NPI Number Information
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NPI Number | 1942659198
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE NORTH
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 2 FIRST AVE SUITE 211
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City | PEABODY
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State | MA
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Zip | 01960-4959
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Country | US
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Telephone | 978-818-6350
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ORTHOPEDICS DR
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City | PEABODY
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State | MA
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Zip | 01960-1668
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY POLANSKY
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Credential |
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Telephone | 978-818-6350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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