Provider Demographics
NPI:1285723049
Name:QUALTER, RICHARD (MSPT, ATC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:QUALTER
Suffix:
Gender:M
Credentials:MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JONES LN
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02562-2538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 ROUTE 137
Practice Address - Street 2:
Practice Address - City:EAST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1316
Practice Address - Country:US
Practice Address - Phone:774-237-0832
Practice Address - Fax:774-408-7164
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA88102251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports