1487604682 NPI number — DEER CROSSING PHYSICAL THERAPY, INC

Table of content: (NPI 1487604682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487604682 NPI number — DEER CROSSING PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEER CROSSING PHYSICAL THERAPY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487604682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 MAIN ST
Provider Second Line Business Mailing Address:
RTE 6A
Provider Business Mailing Address City Name:
DENNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02638-1906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-385-9999
Provider Business Mailing Address Fax Number:
508-385-4590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
193 WHITES PATH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
S YARMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02664-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-398-6477
Provider Business Practice Location Address Fax Number:
508-398-6477
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGLETON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-385-9999

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA32600 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y61404 . This is a "BCBS MA GROUP NO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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