Provider Demographics
NPI:1144745902
Name:SUSTAIN PHYSICAL THERAPY AND PERFORMANCE
Entity type:Organization
Organization Name:SUSTAIN PHYSICAL THERAPY AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:617-936-8631
Mailing Address - Street 1:364 BOYLSTON ST STE 401
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3806
Mailing Address - Country:US
Mailing Address - Phone:617-936-8631
Mailing Address - Fax:
Practice Address - Street 1:364 BOYLSTON ST STE 401
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3806
Practice Address - Country:US
Practice Address - Phone:617-936-8631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-13
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy