MEDICARE: NANTASKET 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1790078665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANTASKET PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	121 NANTASKET AVE
Second Line	:	SUITE105
City	:	HULL
State	:	MA
Zip	:	02045
Country	:	US
Telephone Number	:	781-925-0747
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 NANTASKET AVE
Second Line	:	SUITE 105
City	:	HULL
State	:	MA
Zip	:	02045-3106
Country	:	US
Telephone Number	:	781-925-0747
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/MANAGER
Name	:	CANDICE O'CONNELL
Credential	:
Telephone Number	:	617-529-4895

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	09/06/2022

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