Provider Demographics
NPI:1063082493
Name:PT PREHAB LLC
Entity type:Organization
Organization Name:PT PREHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY JO
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PT
Authorized Official - Phone:508-315-9229
Mailing Address - Street 1:70 MARLBOROUGH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2036
Mailing Address - Country:US
Mailing Address - Phone:508-315-9229
Mailing Address - Fax:
Practice Address - Street 1:70 MARLBOROUGH ST APT 10
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2036
Practice Address - Country:US
Practice Address - Phone:508-315-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy