MEDICARE: PROFESSIONAL THERAPY ASSOCIATES, 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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	698229	OTHER		TUFTS

General Provider Information

NPI Number	:	1346228756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL THERAPY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	67 MILLBROOK ST
Second Line	:	SUITE 211
City	:	WORCESTER
State	:	MA
Zip	:	01606-2835
Country	:	US
Telephone Number	:	508-792-9955
Fax Number	:	508-792-9943

Provider Business Practice Location Address
First Line	:	67 MILLBROOK ST
Second Line	:	SUITE 211
City	:	WORCESTER
State	:	MA
Zip	:	01606-2835
Country	:	US
Telephone Number	:	508-792-9955
Fax Number	:	508-792-9943

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. EUGENE R LAMBERT
Credential	:	PT
Telephone Number	:	508-792-9955

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	03/04/2008

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