Provider Demographics
NPI:1902127913
Name:OFF-SEASON SPORTS & PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:OFF-SEASON SPORTS & PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC/L, CSCS
Authorized Official - Phone:413-335-2925
Mailing Address - Street 1:1820 TURNPIKE ST # 200
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6327
Mailing Address - Country:US
Mailing Address - Phone:978-688-6181
Mailing Address - Fax:
Practice Address - Street 1:1600 OSGOOD ST STE 2085
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1048
Practice Address - Country:US
Practice Address - Phone:978-688-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18051261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy