1447259163 NPI number — MASSACHUSETTS MEDICAL & PHYSICAL THERAPY ASSOCIATES INC.

Table of content: (NPI 1447259163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447259163 NPI number — MASSACHUSETTS MEDICAL & PHYSICAL THERAPY ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSACHUSETTS MEDICAL & PHYSICAL THERAPY ASSOCIATES 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:
FITZGERALD PHYSICAL THERAPY ASSOCIATES, INC.
Provider Other Organization Name Type Code:
3
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:
1447259163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W CUMMINGS PARK
Provider Second Line Business Mailing Address:
SUITE 2100
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-6503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-305-4656
Provider Business Mailing Address Fax Number:
781-305-4658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W CUMMINGS PARK
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-305-4656
Provider Business Practice Location Address Fax Number:
781-305-4658
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FITZGERALD
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/SUPERVISING PT
Authorized Official Telephone Number:
781-305-4656

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  551184 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9775978 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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