1366645012 NPI number — KAREN HOLMES PHYSICAL THERAPY, LLC

Table of content: (NPI 1366645012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366645012 NPI number — KAREN HOLMES PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAREN HOLMES PHYSICAL THERAPY, 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:
1366645012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01952-1814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-500-9586
Provider Business Mailing Address Fax Number:
978-499-1871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01952-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-500-9586
Provider Business Practice Location Address Fax Number:
978-499-1871
Provider Enumeration Date:
06/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OF PHYSICAL THERAPY
Authorized Official Telephone Number:
978-499-1870

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  4094 , 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: 0002051 . This is a "MEDICARE P TAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y66189 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA89049 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 08Y010803MA02 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1588653034 . This is a "INDIVIDUAL NPI #" identifier . This identifiers is of the category "OTHER".




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