NPIMap

Organization Active NPI

South Shore Sports & Muscular

  • Orthopedic Physical Therapist
  • East Weymouth, MA
National Provider Identifier
1104822576
Registry record updated Dec 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
5290 Issued in MA
Legal business name
SOUTH SHORE SPORTS & MUSCULAR
Practice address
90 Libbey Industrial Pkwy
Ste 103
East Weymouth, MA 02189-3129
Phone
(781) 331-9600
Fax
(781) 335-1556
NPI assigned
Jun 22, 2005
Last updated
Dec 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2011

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

Authorized official

Name
Mr. Stephen Lally Newcomb
Title
General Manager
Phone
(781) 331-9600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 5290 MA Primary

Addresses

Primary practice location

90 Libbey Industrial Pkwy
Ste 103
East Weymouth, MA 02189-3129

Mailing address

90 Libbey Industrial Pkwy
Ste 103
East Weymouth, MA 02189-3129
Phone (781) 331-9600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323000056 MA Part B Supplier - Clinic/Group Practice 5092606764 Receives reassigned benefits from 4 practitioners
Practice locations: Quincy, MA

National Provider Directory

National Provider Directory

Locations

300 Congress St
Ste 202
Quincy, MA 02169
Phone (617) 471-7333

300 Congress St
Ste 204
Quincy, MA 02169
Phone (617) 461-7333

500 Congress St
Ste 1C
Quincy, MA 02169
Phone (617) 471-1300

541 Main St
Ste 103
South Weymouth, MA 02190
Phone (781) 331-9600

90 Libbey Park
Ste 103
Weymouth, MA 02189
Phone (781) 331-9600

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324252800000",
    "number": "1104822576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 LIBBEY INDUSTRIAL PKWY",
            "address_2": "STE 103",
            "city": "EAST WEYMOUTH",
            "state": "MA",
            "postal_code": "021893129",
            "telephone_number": "781-331-9600",
            "fax_number": "781-335-1556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 LIBBEY INDUSTRIAL PKWY",
            "address_2": "STE 103",
            "city": "EAST WEYMOUTH",
            "state": "MA",
            "postal_code": "021893129",
            "telephone_number": "781-331-9600",
            "fax_number": "781-335-1556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE SPORTS & MUSCULAR",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2011-12-19",
        "status": "A",
        "authorized_official_last_name": "NEWCOMB",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "LALLY",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "781-331-9600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MA",
            "license": "5290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Weymouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.