MEDICARE: MULTISPORT DOCTORS OF PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1245733906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTISPORT DOCTORS OF PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	60 AUSTIN ST STE 103
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02460-1857
Country	:	US
Telephone Number	:	857-226-8200
Fax Number	:	857-226-8099

Provider Business Practice Location Address
First Line	:	60 AUSTIN ST STE 103
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02460-1857
Country	:	US
Telephone Number	:	857-226-8200
Fax Number	:	857-226-8099

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT WILLIAM STRACHAN
Credential	:	DPT
Telephone Number	:	857-226-8200

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	03/08/2018

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