Provider Demographics
NPI:1154568210
Name:CLIFTONDALE PHYSICAL THERAPY
Entity type:Organization
Organization Name:CLIFTONDALE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-231-0007
Mailing Address - Street 1:558 LINCOLN AVE #3
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906
Mailing Address - Country:US
Mailing Address - Phone:781-231-0007
Mailing Address - Fax:
Practice Address - Street 1:558 LINCOLN AVE # 3
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3850
Practice Address - Country:US
Practice Address - Phone:781-231-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy