Provider Demographics
NPI:1154711489
Name:BLUE HILLS PHYSICAL THERAPY CENTER, LLC
Entity type:Organization
Organization Name:BLUE HILLS PHYSICAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:715-563-4308
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-0040
Mailing Address - Country:US
Mailing Address - Phone:715-458-0255
Mailing Address - Fax:715-458-0253
Practice Address - Street 1:1070 N 1ST ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WI
Practice Address - Zip Code:54822-2000
Practice Address - Country:US
Practice Address - Phone:715-458-0255
Practice Address - Fax:715-458-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty