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Organization
ORTHOPEDIC BACK AND SPORTS CENTER INC
Active
Organization
ORTHOPEDIC BACK AND SPORTS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANNON M WALTON MSPT (PRESIDENT)
(781) 938-5387
Entity
Organization
Contact information
Practice address
7 ALFRED ST, WOBURN, MA 01801-1976
(781) 938-5387
(781) 503-5039
Mailing address
7 ALFRED ST, WOBURN, MA 01801-1976
(781) 938-5387
(781) 503-5039
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10570
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64-00320
UNITED HEALTH
MA
01
—
689253
TUFTS
MA
01
—
AA43298
HARVARD PILGRIM
MA
01
—
Y61259
BLUE CROSS
MA
Enumeration date
01/16/2007
Last updated
08/22/2020
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