Provider Demographics
NPI:1285611467
Name:COMPREHENSIVE PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:COMPREHENSIVE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-892-1335
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1313
Mailing Address - Country:US
Mailing Address - Phone:508-892-1335
Mailing Address - Fax:508-892-1780
Practice Address - Street 1:1037 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1313
Practice Address - Country:US
Practice Address - Phone:508-892-1335
Practice Address - Fax:508-892-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0003082Medicare PIN