1821108549 NPI number — BAY STATE PHYSICAL THERAPY OF RANDOLPH 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 1821108549 NPI number — BAY STATE PHYSICAL THERAPY OF RANDOLPH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY STATE PHYSICAL THERAPY OF RANDOLPH 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:
BAY STATE PHYSICAL THERAPY OF RANDOLPH INC
Provider Other Organization Name Type Code:
4
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:
1821108549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 GRANITE ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAINTREE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02184-5350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-961-3370
Provider Business Mailing Address Fax Number:
781-961-1291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 FORGE HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02038-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-541-9111
Provider Business Practice Location Address Fax Number:
508-541-7830
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINDWER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
781-961-3370

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9706501 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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