Provider Demographics
NPI:1215320668
Name:MIDDLESEX PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MIDDLESEX PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-452-6795
Mailing Address - Street 1:716 MIDDLESEX ST
Mailing Address - Street 2:UNIT 6
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1400
Mailing Address - Country:US
Mailing Address - Phone:978-452-6795
Mailing Address - Fax:978-452-6302
Practice Address - Street 1:716 MIDDLESEX ST
Practice Address - Street 2:UNIT 6
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1400
Practice Address - Country:US
Practice Address - Phone:978-452-6795
Practice Address - Fax:978-452-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy