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Organization

CRITERION

Active
Other names
wachusett
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SALLY GOODHILE (PHYSICAL THERAPIST)
(978) 632-4423
Entity
Organization

Contact information

Practice address
15 MANNING ST, JEFFERSON, MA 01522-1570
(508) 825-0621
Mailing address
31 LAKE ST, 180, GARDNER, MA 01440-3879
(978) 632-4432
(978) 632-6022

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
253Z00000X
In Home Supportive Care Agency
5211
MA
261QP2000X
Physical Therapy Clinic/Center
Primary
5211
MA
302F00000X
Exclusive Provider Organization
5211
MA

Other

Enumeration date
03/13/2014
Last updated
03/13/2014
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