NPI 1104639731
Clinic/Center, Physical Therapy in Waltham, Massachusetts
1104639731- Practice location
- 40 Crescent St Ste 104, Waltham, MA 02453-4313
- Phone
- 781-916-8825
- Fax
- 781-701-3570
- Last updated
- February 9, 2025
NPI 1104639731 is a healthcare organization based in Waltham, MA. NPI 1104639731 practices in Waltham, MA. The NPI Number for NPI 1104639731 is 1104639731. The current practice location address for NPI 1104639731 is 40 Crescent St Ste 104, Waltham, MA 02453-4313 and can be reached out via phone at 781-916-8825 and via fax at 781-701-3570.
Provider Profile Details
- NPI Number
- 1104639731
- Provider Name
- NPI 1104639731
- Provider Entity Type
- Organization
- Address
- 40 Crescent St Ste 104, Waltham, MA 02453-4313
- Phone Number
- 781-916-8825
- Fax Number
- 781-701-3570
- Primary Taxonomy
- Clinic/Center, Physical Therapy · 261QP2000X
- Organization Subpart
- No
- Authorized Official
- Yolanda Enid Rodriguez, PTA · President · 781-916-8825
- Provider Enumeration Date
- January 28, 2025
- Last Update Date
- February 9, 2025
- Certification Date
- February 9, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 40 Crescent St Ste 104
Waltham, MA 02453-4313 - City
- Waltham
- State
- Massachusetts
- Zip
- 02453-4313
- Phone Number
- 781-916-8825
- Fax Number
- 781-701-3570
Provider Business Mailing Address Details
- Address
- 40 Crescent St Ste 104
Waltham, MA 02453-4313 - City
- Waltham
- State
- MA
- Zip
- 02453-4313
- Phone Number
- 781-916-8825
- Fax Number
- 781-701-3570
License Information
- Taxonomy
- Clinic/Center, Physical Therapy · 261QP2000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of NPI 1104639731?
The NPI number of NPI 1104639731 is 1104639731. It was assigned on January 28, 2025 and is currently active in the NPPES registry.
What is the specialty of NPI 1104639731?
NPI 1104639731 is registered under the primary taxonomy Clinic/Center, Physical Therapy (code 261QP2000X).
Where does NPI 1104639731 practice?
The practice location is 40 Crescent St Ste 104, Waltham, MA 02453-4313. The office can be reached at 781-916-8825 (phone) or 781-701-3570 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1104639731 directly on the NPPES registry website.