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Organization
THERAFIT-TEWKSBURY, INC.
Active
Organization
THERAFIT-TEWKSBURY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD DOUGLAS MOULTON P.T. (PRESIDENT)
(978) 858-0002
Entity
Organization
Contact information
Practice address
1487 MAIN ST, TEWKSBURY, MA 01876-2043
(978) 858-0002
(978) 858-0180
Mailing address
1487 MAIN ST, TEWKSBURY, MA 01876-2043
(978) 858-0002
(978) 858-0180
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
185
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
612645
HARVARD PILGRIM
MA
01
—
730055
TUFTS HEALTH PLAN
MA
05
—
9722190
—
MA
01
—
Y65668
BLUE CROSS
MA
Enumeration date
02/15/2007
Last updated
12/21/2007
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