Organization
MIND BODY SOUL PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW JAMES PENQUE PT (OWNER/LEAD PHYSICAL THERAPIST)
(716) 425-6625
Entity
Organization
Contact information
Practice address
836 BRIDGE ST APT 16, LOWELL, MA 01850-1610
(716) 425-6625
Mailing address
836 BRIDGE ST APT 16, LOWELL, MA 01850-1610
(716) 425-6625
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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