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NPI Code Detail

MEDICARE: PROFESSIONAL PHYSICAL THERAPY & SPORTS MEDICINE, LLC

MEDICARE: PROFESSIONAL PHYSICAL THERAPY & SPORTS MEDICINE, 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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1605813OTHERMAHARVARD-PILGRIM HEALTHPLA
2Y65686OTHERMABLUE CROSS OF MA
3726552OTHERMATUFTS HEALTHPLAN

General Provider Information

NPI Number : 1427002831
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL PHYSICAL THERAPY & SPORTS MEDICINE, LLC
Provider Business Mailing Address
First Line : 620 OLD WEST CENTRAL ST
Second Line :
City : FRANKLIN
State : MA
Zip : 02038-2912
Country : US
Telephone Number : 508-528-6100
Fax Number : 508-528-6304
Provider Business Practice Location Address
First Line : 620 OLD WEST CENTRAL ST
Second Line :
City : FRANKLIN
State : MA
Zip : 02038-2912
Country : US
Telephone Number : 508-528-6100
Fax Number : 508-528-6304
Authorized Official
Title or Position : DIRECTOR OF REHAB/PRESIDENT
Name : DR. STACEY L RAYBUCK
Credential : PT, DPT, MS, OCS
Telephone Number : 508-528-6100
Provider Enumeration Date : 05/20/2006
Last Update Date : 05/03/2019

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Directions to “PROFESSIONAL PHYSICAL THERAPY & SPORTS MEDICINE, LLC ” Practice Location

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