Provider Demographics
NPI:1528113750
Name:SANDWICH PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:SANDWICH PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-477-8550
Mailing Address - Street 1:61 QUAKER MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2400
Mailing Address - Country:US
Mailing Address - Phone:508-477-8550
Mailing Address - Fax:508-477-6989
Practice Address - Street 1:61 QUAKER MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2400
Practice Address - Country:US
Practice Address - Phone:508-477-8550
Practice Address - Fax:508-477-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0105Medicare PIN