1255894903 NPI number — STILL MOTION THERAPEUTIC SERVICES LLC

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 1255894903 NPI number — STILL MOTION THERAPEUTIC SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STILL MOTION THERAPEUTIC SERVICES 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:
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:
1255894903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX: 470602
Provider Second Line Business Mailing Address:
207 WASHINGTON ST.
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-858-8017
Provider Business Mailing Address Fax Number:
617-207-9709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 MERRIMACK ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-858-6916
Provider Business Practice Location Address Fax Number:
617-207-9709
Provider Enumeration Date:
04/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MEIDANIS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
ELENA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
617-858-8017

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1902353758 . This is a "BAY STATE COMMUNITY SERVICES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com