Provider Demographics
NPI: | 1083378202 |
---|---|
Name: | ANCHOR PHYSICAL THERAPY LLC |
Entity type: | Organization |
Organization Name: | ANCHOR PHYSICAL THERAPY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KERRY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FOGARTY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSPT |
Authorized Official - Phone: | 781-783-5373 |
Mailing Address - Street 1: | 3 MILL WHARF PLZ STE N11 |
Mailing Address - Street 2: | |
Mailing Address - City: | SCITUATE |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02066-1379 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 781-783-5373 |
Mailing Address - Fax: | 781-987-9267 |
Practice Address - Street 1: | 3 MILL WHARF PLZ STE N11 |
Practice Address - Street 2: | |
Practice Address - City: | SCITUATE |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02066-1379 |
Practice Address - Country: | US |
Practice Address - Phone: | 781-783-5373 |
Practice Address - Fax: | 781-987-9267 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-10-25 |
Last Update Date: | 2021-10-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |