1730275942 NPI number — HOUGHTON PHYSICAL THERAPY & SPORTS CONDITIONING, LLC

Table of content: (NPI 1730275942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730275942 NPI number — HOUGHTON PHYSICAL THERAPY & SPORTS CONDITIONING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUGHTON PHYSICAL THERAPY & SPORTS CONDITIONING, LLC
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:
LIMITED LIABILITY COMPANY
Provider Other Organization Name Type Code:
5
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:
1730275942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 865
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-223-2300
Provider Business Mailing Address Fax Number:
508-223-2340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-223-2300
Provider Business Practice Location Address Fax Number:
508-223-2340
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOUGHTON
Authorized Official First Name:
TODD
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER PHYSICAL THERAPIST
Authorized Official Telephone Number:
508-223-2300

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 387 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: DP9318 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9725300 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA16980 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y61358 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1730275942 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PT0202 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 610889 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000026914 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 92826 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".




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