MEDICARE: PATRIOT ALL PRO PHYSICAL THERAPY CENTERS

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	174400000X	Specialist	229	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y61278	OTHER	MA	BLUE CROSS BLUE SHIELD OF MA
2	24063	OTHER	MA	BMC HEALTH NET
3	626334	OTHER	MA	HARVARD PILGRIM HEALTHCARE
4	695105	OTHER	MA	TUFTS HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0033304	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
7	9720430	OTHER	MA	MASS HEALTH
8	968175	OTHER	MA	NETWORK HEALTH

General Provider Information

NPI Number	:	1841348505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRIOT ALL PRO PHYSICAL THERAPY CENTERS

Provider Business Mailing Address
First Line	:	348 N PEARL ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-1197
Country	:	US
Telephone Number	:	508-897-0056
Fax Number	:	508-584-5630

Provider Business Practice Location Address
First Line	:	348 N PEARL ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-1197
Country	:	US
Telephone Number	:	508-897-0056
Fax Number	:	508-584-5630

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. RHONDA P. TIPPETT
Credential	:
Telephone Number	:	508-897-0056

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/20/2008

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