Individual provider Active NPI

Andrew Young

  • Physical Therapist
  • Waltham, MA
National Provider Identifier
1063812477
Registry record updated Sep 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
21174 Issued in MA
Practice address
564 Main St
Waltham, MA 02452-5516
Phone
(781) 894-8880
NPI assigned
Sep 4, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2014

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 21174 MA Primary

Addresses

Primary practice location

564 Main St
Waltham, MA 02452-5516

Mailing address

564 Main St
Waltham, MA 02452-5516
Phone (781) 894-8880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150313000629 MA Practitioner - Physical Therapist in Private Practice 1254657091 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Greendale Physical Therapy, LLC Physical Therapist CurrentSince Jan 7, 2019 Accepting new patients
Blackstone Valley Physical Therapy Services Inc Physical Therapist CurrentSince Nov 18, 2019 Accepting new patients
Patient First Chiropractic and Physical Therapy PC CurrentSince Aug 4, 2014 Accepting new patients

Locations

280 Boston Tpke
Shrewsbury, MA 01545
Phone (508) 753-7780

564 Main St
Waltham, MA 02452
Phone (781) 693-3800

670 Linwood Ave
Ste 2
Whitinsville, MA 01588
Phone (508) 234-7544

120 Gold Star Blvd
Worcester, MA 01606
Phone (508) 459-5000

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": "1409788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409788800000",
    "number": "1063812477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "564 MAIN ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024525516",
            "telephone_number": "781-894-8880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 MAIN ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024525516",
            "telephone_number": "781-894-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "21174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.