Organization
SOUTH SHORE INJURY TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY A PROVENZANO (TREASURER)
(617) 689-0440
Entity
Organization
Contact information
Practice address
25 SCHOOL ST, B2, QUINCY, MA 02169-6607
(617) 689-0440
(617) 689-0420
Mailing address
25 SCHOOL ST, B2, QUINCY, MA 02169-6607
(617) 689-0440
(617) 689-0420
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
80064
MA
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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