Provider Demographics
NPI:1194723478
Name:PHYSICAL THERAPY CENTER, INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MBA
Authorized Official - Phone:508-428-0300
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-0604
Mailing Address - Country:US
Mailing Address - Phone:508-428-0300
Mailing Address - Fax:508-428-1211
Practice Address - Street 1:719 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1903
Practice Address - Country:US
Practice Address - Phone:508-428-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61076OtherBCBS
MA9799931Medicaid
PT0028Medicare ID - Type Unspecified