NPIMap

Organization Active NPI

McGovern Physical Therapy Associates LLC

  • Physical Therapy Clinic/Center
  • Malden, MA
National Provider Identifier
1043200330
Registry record updated Dec 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
9964 Issued in MA
Legal business name
MCGOVERN PHYSICAL THERAPY ASSOCIATES LLC
Practice address
350 Main St
Suite 205
Malden, MA 02148-5089
Phone
(781) 321-2727
Fax
(781) 321-4995
NPI assigned
Oct 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven N Davidson
Title
Ceo
Phone
(616) 356-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 9964 MA Primary

Addresses

Primary practice location

350 Main St
Suite 205
Malden, MA 02148-5089

Mailing address

350 Main St
Suite 205
Malden, MA 02148-5089
Phone (781) 321-2727

Other identifiers 5

IdentifierTypeStateIssuer
0327328MedicaidMA
626293OtherMAHARVARD PROVIDER NUMBER
687260OtherMATUFTS
Y61240OtherMABLUE CROSS BLUE SHIELD
9729861MedicaidMA

National Provider Directory

National Provider Directory

Locations

350 Main St
#1
Malden, MA 02148
Phone (781) 321-2727

350 Main St
Ste 205
Malden, MA 02148
Phone (781) 321-2727

385 Broadway
Ste 205
Revere, MA 02151
Phone (781) 485-1001

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1043200330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 MAIN ST",
            "address_2": "SUITE 205",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485089",
            "telephone_number": "781-321-2727",
            "fax_number": "781-321-4995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 MAIN ST",
            "address_2": "SUITE 205",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485089",
            "telephone_number": "781-321-2727",
            "fax_number": "781-321-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCGOVERN PHYSICAL THERAPY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "616-356-5000"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MA",
            "license": "9964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0327328",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PROVIDER NUMBER",
            "identifier": "626293",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "687260",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y61240",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9729861",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Malden, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.