1639298623 NPI number — ADVANCED PHYSICAL THEARPY SERVICES INC

Table of content: (NPI 1639298623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639298623 NPI number — ADVANCED PHYSICAL THEARPY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PHYSICAL THEARPY SERVICES 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:
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:
1639298623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67373
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTNUT HILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02467-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-277-8400
Provider Business Mailing Address Fax Number:
617-277-8401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1651 BLUE HILL AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
MATTAPAN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02126-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-296-3951
Provider Business Practice Location Address Fax Number:
617-296-1036
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZASLAVSKI
Authorized Official First Name:
REUVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-277-8400

Provider Taxonomy Codes

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

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

  • Identifier: 9785698 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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