| |
1738 Grand Army Hwy, Swansea, MA 02777-3906 | |
(508) 379-0090 | |
(508) 379-6050 |
Full Name | |
---|---|
Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 1738 Grand Army Hwy, Swansea, Massachusetts |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1871657163 | NPI | - | NPPES |
VX0303 | Other | MA | PTAN |
1942249651 | Other | MA | NPI (INDIVIDUAL) |
1871657163 | Other | MA | NPI (GROUP) |
1831401405 | Other | MA | NPI (INDIVIDUAL) |
VX2642 | Other | MA | PTAN |
1100844814A | Medicaid | MA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 8384 (Massachusetts) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | 338 (Massachusetts) | Primary |
Provider Name | Jeffrey M Botelho |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1942249651 PECOS PAC ID: 0941266720 Enrollment ID: I20041203000170 |
Mailing Address | Practice Location Address |
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1738 Grand Army Highway, Swansea, MA 02777 Ph: (508) 379-0090 | 1738 Grand Army Hwy, Swansea, MA 02777-3906 Ph: (508) 379-0090 |