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Organization
PROFESSIONAL PHYSICAL THERAPY & SPORTS MEDICINE, LLC
Active
Organization
PROFESSIONAL PHYSICAL THERAPY & SPORTS MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY L RAYBUCK PT, DPT, MS, OCS (DIRECTOR OF REHAB/PRESIDENT)
(508) 528-6100
Entity
Organization
Contact information
Practice address
620 OLD WEST CENTRAL ST, FRANKLIN, MA 02038-2912
(508) 528-6100
(508) 528-6304
Mailing address
620 OLD WEST CENTRAL ST, FRANKLIN, MA 02038-2912
(508) 528-6100
(508) 528-6304
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
605813
HARVARD-PILGRIM HEALTHPLA
MA
01
—
726552
TUFTS HEALTHPLAN
MA
01
—
Y65686
BLUE CROSS OF MA
MA
Enumeration date
05/20/2006
Last updated
05/03/2019
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