Provider Demographics
NPI:1871133165
Name:EASTERN PHYSICAL THERAPY
Entity type:Organization
Organization Name:EASTERN PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANBUNNARITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-866-2616
Mailing Address - Street 1:74 FORT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2709
Mailing Address - Country:US
Mailing Address - Phone:978-866-2616
Mailing Address - Fax:
Practice Address - Street 1:851 MIDDLESEX ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1419
Practice Address - Country:US
Practice Address - Phone:978-866-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty