1407833718 NPI number — LOUIS B. COIRO, INC.

Table of content: (NPI 1407833718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407833718 NPI number — LOUIS B. COIRO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUIS B. COIRO, 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:
TEWKSBURY PHYSICAL THERAPY
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:
1407833718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
885 MAIN ST
Provider Second Line Business Mailing Address:
UNIT #4
Provider Business Mailing Address City Name:
TEWKSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01876-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-851-8768
Provider Business Mailing Address Fax Number:
978-851-8606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 MAIN ST
Provider Second Line Business Practice Location Address:
UNIT 4
Provider Business Practice Location Address City Name:
TEWKSBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01876-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-851-8768
Provider Business Practice Location Address Fax Number:
978-851-8606
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLUTE
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
978-851-8768

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 87726 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 709987 . This is a "TUFT HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y65627 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 40400 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 605420 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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