Provider Demographics
NPI:1366186215
Name:YOUR PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:YOUR PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:FRIGON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:508-981-0301
Mailing Address - Street 1:1080 OAKHILL AVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-7319
Mailing Address - Country:US
Mailing Address - Phone:508-981-0301
Mailing Address - Fax:
Practice Address - Street 1:1080 OAKHILL AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-7319
Practice Address - Country:US
Practice Address - Phone:508-981-0301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty