1962792564 NPI number — MOBILITY PLUS PHYSICAL THERAPY

Table of content: (NPI 1962792564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962792564 NPI number — MOBILITY PLUS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILITY PLUS PHYSICAL THERAPY
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:
1962792564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 HAZELWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02359-2127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-293-0056
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
193 ROCKLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02339-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-826-2200
Provider Business Practice Location Address Fax Number:
781-826-2221
Provider Enumeration Date:
04/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TARANTINO
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-254-7560

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  11514 , 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: 703674 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 8413153001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 600719 . This is a "HARVARD PILGRIM HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6400037 . This is a "UNITED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 97421742 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y65618 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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