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NPI Code Detail

MEDICARE: PLYMOUTH REGIONAL REHABILITATION SERVICES LLC

MEDICARE: PLYMOUTH REGIONAL REHABILITATION SERVICES 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
1225X00000XOccupational Therapist
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1780986539
Entity Type Code : Organization
Provider Name (Legal Business Name) : PLYMOUTH REGIONAL REHABILITATION SERVICES LLC
Provider Business Mailing Address
First Line : 60 LYME ST
Second Line :
City : OLD LYME
State : CT
Zip : 06371-2332
Country : US
Telephone Number : 860-434-9398
Fax Number : 860-434-0739
Provider Business Practice Location Address
First Line : 790 LAKE ST
Second Line :
City : BRISTOL
State : NH
Zip : 03222-4548
Country : US
Telephone Number : 603-744-0275
Fax Number : 603-744-9378
Authorized Official
Title or Position : VP FINANCE
Name : MICHAEL FORTUNATO
Credential :
Telephone Number : 860-434-9398
Provider Enumeration Date : 11/30/2010
Last Update Date : 02/09/2011

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Directions to “PLYMOUTH REGIONAL REHABILITATION SERVICES LLC ” Practice Location

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