Provider Demographics
NPI:1124096052
Name:ROURKE, MICHAEL J (MSPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:ROURKE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:322 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1824
Mailing Address - Country:US
Mailing Address - Phone:508-559-0993
Mailing Address - Fax:
Practice Address - Street 1:110 LIBERTY ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5521
Practice Address - Country:US
Practice Address - Phone:508-580-0144
Practice Address - Fax:508-580-0449
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA417280OtherTUFTS
MA1017758OtherFALLON
MAY67392OtherBLUECROSS BLUESHIELD
MA00000003237OtherBOSTON MEDICAL CENTER HEALTHNET
MA0316547Medicaid