1447259163 NPI number — MASSACHUSETTS MEDICAL & PHYSICAL THERAPY ASSOCIATES INC.

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 1447259163 NPI number — MASSACHUSETTS MEDICAL & PHYSICAL THERAPY ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSACHUSETTS MEDICAL & PHYSICAL THERAPY ASSOCIATES 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:
Provider Other Organization Name Type Code:
6
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:
1447259163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W CUMMINGS PARK
Provider Second Line Business Mailing Address:
SUITE 2100
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-6503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-305-4656
Provider Business Mailing Address Fax Number:
781-305-4658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W CUMMINGS PARK
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-305-4656
Provider Business Practice Location Address Fax Number:
781-305-4658
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FITZGERALD
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/SUPERVISING PT
Authorized Official Telephone Number:
781-305-4656

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  551184 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9775978 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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