Provider Demographics
NPI:1285689927
Name:GREENBERG, MARK (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-5501
Mailing Address - Country:US
Mailing Address - Phone:508-473-0862
Mailing Address - Fax:508-473-3229
Practice Address - Street 1:37 BIRCH ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-473-0862
Practice Address - Fax:508-473-3229
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MA15483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15483OtherPT