Provider Demographics
NPI:1528298296
Name:MGH REVERE HEALTHCARE CENTRE
Entity type:Organization
Organization Name:MGH REVERE HEALTHCARE CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RUCHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:VORA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT
Authorized Official - Phone:1781-485-6222
Mailing Address - Street 1:190 MOUNTAIN AVE
Mailing Address - Street 2:APT # 404
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2762
Mailing Address - Country:US
Mailing Address - Phone:508-615-9191
Mailing Address - Fax:
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3675
Practice Address - Country:US
Practice Address - Phone:781-485-6222
Practice Address - Fax:781-485-6232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASSACHUSETTS GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18434261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy