Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 225100000X | Physical Therapist | | 8522 | MASSACHUSETTS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
1 | P3276069 | OTHER | MASSACHUSETTS | OXFORD NON PAR |
2 | 0359726 | MEDICAID | MASSACHUSETTS | |
3 | 080008522MA04 | OTHER | MASSACHUSETTS | ANTHEM BC BS |
4 | 103355100 | OTHER | MASSACHUSETTS | DEPT. OF LABOR |
5 | 28117 | OTHER | MASSACHUSETTS | HEALTH NEW ENGLAND |
6 | Y61264 | OTHER | MASSACHUSETTS | BLUE CROSS BLUE SHIELD |
7 | 043527497 | OTHER | MASSACHUSETTS | CONSOLIDATED |
8 | 043527497 | OTHER | MASSACHUSETTS | GREATWEST |
9 | 043527497 | OTHER | MASSACHUSETTS | UNITED HEALTHCARE |
10 | 690675 | OTHER | MASSACHUSETTS | TUFTS GROUP NO |
11 | 000000035308 | OTHER | MASSACHUSETTS | BOSTON MEDICAL HEALTH NET INDIVIDUAL NO |
12 | Y66897 | OTHER | MASSACHUSETTS | BLUE CROSS BLUE SHIELD INDIVIDUAL NO |
13 | 043527497 | OTHER | MASSACHUSETTS | NORTH REGION/TRICARE |
14 | 468856 | OTHER | MASSACHUSETTS | TUFTS INDIVIDUAL NO |
15 | 000000035264 | OTHER | MASSACHUSETTS | BOSTON MEDICAL HEALTH NET GROUP NO |
16 | 0359726 | OTHER | MASSACHUSETTS | NETWORK HEALTH GROUP |
17 | 043527497 | OTHER | MASSACHUSETTS | AETNA |
18 | 043527497 | OTHER | MASSACHUSETTS | CIGNA GROUP NO |
19 | 650021465 | OTHER | MASSACHUSETTS | PALMETTO RR MEDICARE |
20 | PT0191 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | GROUP |
21 | 4543850 | OTHER | MASSACHUSETTS | AETNA INDIVIDUAL NO |
22 | 7138200 | OTHER | MASSACHUSETTS | CIGNA INDIVIDUAL NO |
23 | 043527 | OTHER | MASSACHUSETTS | CONNECTICARE |
24 | 043527497 | OTHER | MASSACHUSETTS | GIC/UNICARE |
25 | 043527497 | OTHER | MASSACHUSETTS | PIONEER |
26 | 11222560 | OTHER | MASSACHUSETTS | CAQH |
27 | Y68641 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | INDIVIDUAL |
28 | 9715568 | MEDICAID | MASSACHUSETTS | |