Provider Demographics
NPI:1053786343
Name:EVERETT COMMUNITY PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:EVERETT COMMUNITY PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDESIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-434-2006
Mailing Address - Street 1:563 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3749
Mailing Address - Country:US
Mailing Address - Phone:617-294-2385
Mailing Address - Fax:
Practice Address - Street 1:563 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3749
Practice Address - Country:US
Practice Address - Phone:617-294-2385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty