1205140795 NPI number — INNER BRIDGES PHYSICAL THERAPY AND WELLNESS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205140795 NPI number — INNER BRIDGES PHYSICAL THERAPY AND WELLNESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNER BRIDGES PHYSICAL THERAPY AND WELLNESS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205140795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 ALEWIFE BROOK PARKWAY
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-491-7400
Provider Business Mailing Address Fax Number:
617-491-7402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 ALEWIFE BROOK PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-491-7400
Provider Business Practice Location Address Fax Number:
617-491-7402
Provider Enumeration Date:
07/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HELINSKI
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
HOPE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-491-7400

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT-17087 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: P.T.#15611 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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