Provider Demographics
NPI:1699072132
Name:ADVANCED ORTHOPEDIC AND SPORTS THERAPY, P.C.
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDIC AND SPORTS THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANFREDI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-452-3453
Mailing Address - Street 1:109 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2234
Mailing Address - Country:US
Mailing Address - Phone:978-505-7219
Mailing Address - Fax:
Practice Address - Street 1:600 CLARK RD
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1699
Practice Address - Country:US
Practice Address - Phone:978-452-3453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy