Organization
IMPACT SPORTS LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN CARRERA (OWNER)
(617) 549-6296
Entity
Organization
Contact information
Practice address
220 W CUMMINGS PARK, WOBURN, MA 01801-6346
(617) 549-6296
Mailing address
220 W CUMMINGS PARK, WOBURN, MA 01801-6346
(617) 549-6296
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285181552
—
MA
Enumeration date
05/16/2024
Last updated
05/16/2024
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