Individual provider Active NPI

Matthew Penney, PT

  • Physical Therapist
  • Boston, MA
National Provider Identifier
1043291198
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10697 Issued in MA
Practice address
260 Tremont St
Boston, MA 02116-5603
Phone
(617) 636-5175
Fax
(617) 636-5176
NPI assigned
Nov 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10697 MA Primary

Addresses

Primary practice location

260 Tremont St
Boston, MA 02116-5603

Mailing address

260 Tremont St
PO Box 120008
Boston, MA 02112-5603
Phone (617) 636-5175

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120201000390 MA Practitioner - Physical Therapist in Private Practice 4082871199 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sports Rehabilitation Unlimited LLCGroup PAC ID 7618265901, 4 clinicians
Advanced Sports Therapy LLCGroup PAC ID 9133409238, 6 clinicians

Practice addresses (Care Compare)

15 Manning Rd
Middleton, MA 01949-1526
Phone (781) 248-8057

60 Walnut St
Wellesley, MA 02481-2151
Phone (781) 235-5275

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10697MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Sports Therapy, LLC Physical Therapist CurrentSince Nov 15, 2016 Accepting new patients
Sports Rehabilitation Unlimited, LLC Physical Therapist CurrentSince Sep 1, 2016 Accepting new patients
Ortho & Sports Physical Therapy Past Accepting new patients

Locations

15 Manning Rd
Middleton, MA 01949
Phone (781) 248-8057

62 Walnut St
Wellesley Hills, MA 02481
Phone (781) 235-5275

60 Walnut St
Wellesley Hills, MA 02481
Phone (617) 531-9503

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043291198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 TREMONT ST",
            "address_2": "PO BOX 120008",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021125603",
            "telephone_number": "617-636-5175",
            "fax_number": "617-636-5176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 TREMONT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165603",
            "telephone_number": "617-636-5175",
            "fax_number": "617-636-5176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNEY",
        "first_name": "MATTHEW",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "10697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.