1245387018 NPI number — MRS. JOANNA M GERETY PT

Table of content: MRS. JOANNA M GERETY PT (NPI 1245387018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245387018 NPI number — MRS. JOANNA M GERETY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERETY
Provider First Name:
JOANNA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOWARD
Provider Other First Name:
JOANNA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245387018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 RYE STREET
Provider Second Line Business Mailing Address:
STE 125 ABILITIES REHABILITATION CENTER, LLC
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-610-2200
Provider Business Mailing Address Fax Number:
603-610-2202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CAMBRIDGE STREET
Provider Second Line Business Practice Location Address:
C/O ORTHOPAEDICS PLUS
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01803-3766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-229-8011
Provider Business Practice Location Address Fax Number:
781-229-8374
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2912 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 19470 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08Y005403NH01 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 542065286 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3115319 . This is a "TAX ID ORTHOPAEDICS PLUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 626470 . This is a "HPHC PROVIDER NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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