Organization
COMMONWEALTH PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY KNELLER (OWNER)
(781) 963-1697
Entity
Organization
Contact information
Practice address
999 N MAIN ST, RANDOLPH, MA 02368-3072
(781) 963-1697
(781) 963-5770
Mailing address
999 N MAIN ST, RANDOLPH, MA 02368-3072
(781) 963-1697
(781) 963-5770
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6400060
UNITED HEALTHCARE
MA
01
—
AA51230
HARVARD PILGRIM HEALTHCAR
MA
01
—
Y61123
BLUE CROSS BLUE SHIELD
MA
Enumeration date
05/25/2006
Last updated
08/22/2020
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