1871214619 NPI number — CHELSEA WELLNESS AND PHYSICAL THERAPY 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 1871214619 NPI number — CHELSEA WELLNESS AND PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHELSEA WELLNESS AND PHYSICAL THERAPY 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:
1871214619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 BROAD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-581-6333
Provider Business Mailing Address Fax Number:
781-593-9093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 EVERETT AVENUE
Provider Second Line Business Practice Location Address:
UNIT #5.5
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-581-6333
Provider Business Practice Location Address Fax Number:
781-593-9093
Provider Enumeration Date:
09/09/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PYATIGORSKIY
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
617-721-6281

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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