NPIMap

Organization Active NPI

NPI 1104639731

  • Physical Therapy Clinic/Center
  • Waltham, MA
National Provider Identifier
1104639731
Registry record updated Feb 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Practice address
40 Crescent St Ste 104
Waltham, MA 02453-4313
Phone
(781) 916-8825
Fax
(781) 701-3570
NPI assigned
Jan 28, 2025
Last updated
Feb 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2025

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

Authorized official

Name
Yolanda Enid Rodriguez, PTA
Title
President
Phone
(781) 916-8825

Specialties & licenses 1

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

Addresses

Primary practice location

40 Crescent St Ste 104
Waltham, MA 02453-4313

Mailing address

40 Crescent St Ste 104
Waltham, MA 02453-4313
Phone (781) 916-8825

National Provider Directory

National Provider Directory

Locations

40 Crescent St
Ste 104
Waltham, MA 02453
Phone (781) 266-7273

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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": "1738022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739059200000",
    "number": "1104639731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 CRESCENT ST STE 104",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024534313",
            "telephone_number": "781-916-8825",
            "fax_number": "781-701-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 CRESCENT ST STE 104",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024534313",
            "telephone_number": "781-916-8825",
            "fax_number": "781-701-3570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-28",
        "last_updated": "2025-02-09",
        "certification_date": "2025-02-09",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "YOLANDA",
        "authorized_official_middle_name": "ENID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-916-8825",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "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 Feb 9, 2025; 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.