Provider Demographics
NPI:1285706663
Name:DEMARTINO PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:DEMARTINO PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:413-442-0610
Mailing Address - Street 1:1450 EAST STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-442-0610
Mailing Address - Fax:413-442-0689
Practice Address - Street 1:1450 EAST STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-442-0610
Practice Address - Fax:413-442-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0370851Medicaid
Y61168OtherBCBS
Y65044OtherHMOBLUE
MA0370851Medicaid