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Organization

SUPPLEMANTAL HEALTH CARE SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. LUIS E PACHECO PTA (PHYSICAL THERAPIST ASSISTANT)
(617) 407-0592
Entity
Organization

Contact information

Practice address
731 TRUMAN HWY, HYDE PARK, MA 02136
(617) 407-0592
Mailing address
731 TRUMAN HWY, HYDE PARK, MA 02136-3517

Taxonomy

Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
7620
MA

Other

Enumeration date
10/16/2008
Last updated
10/16/2008
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