Provider Demographics
NPI:1861547523
Name:PHYSICAL THERAPY AND FITNESS CENTER OF RAYNHAM, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND FITNESS CENTER OF RAYNHAM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PACCHIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-828-1011
Mailing Address - Street 1:40 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1019
Mailing Address - Country:US
Mailing Address - Phone:508-828-1011
Mailing Address - Fax:508-828-1004
Practice Address - Street 1:675 PARAMOUNT DR
Practice Address - Street 2:SUITE 103
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-5188
Practice Address - Country:US
Practice Address - Phone:508-828-1011
Practice Address - Fax:508-828-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9714375Medicaid
MAPT0142Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER N