NPIMap

Organization Active NPI

Soul Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Beverly, MA
National Provider Identifier
1093118002
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
01852 Issued in MA
Legal business name
SOUL PHYSICAL THERAPY LLC
Practice address
7 Reservoir Rd
Beverly, MA 01915-5501
Phone
(978) 524-0333
Fax
(978) 524-0334
NPI assigned
Oct 4, 2014
Last updated
Jan 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

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

Authorized official

Name
Andrew McLlarky, PTNPI 1518127240
Title
Owner / PT
Phone
(860) 917-5594

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 01852 MA Primary

Addresses

Primary practice location

7 Reservoir Rd
Beverly, MA 01915-5501

Mailing address

7 Reservoir Rd
Beverly, MA 01915-5501
Phone (978) 524-0333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150608001250 MA Part B Supplier - Clinic/Group Practice 5991026544 Receives reassigned benefits from 7 practitioners
Practice locations: Beverly, MA; Danvers, MA

National Provider Directory

National Provider Directory

Locations

10 Elm St
Danvers, MA 01923
Phone (978) 304-0536

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1412380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1093118002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 RESERVOIR RD",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019155501",
            "telephone_number": "978-524-0333",
            "fax_number": "978-524-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 RESERVOIR RD",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019155501",
            "telephone_number": "978-524-0333",
            "fax_number": "978-524-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-04",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "MCLLARKY",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER / PT",
        "authorized_official_telephone_number": "860-917-5594",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MA",
            "license": "01852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; 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.