Active NPI
Mary D Zupkus, PTMPA
- Physical Therapist
- Concord, MA
National Provider Identifier
1104851112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2727
- Practice address
- 290 Baker Ave.
Suite 111
Concord, MA 01742 - Phone
- (978) 369-0730
- Fax
- (978) 371-7499
- NPI assigned
- Jul 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2727 | MA | Primary |
| Physical Therapist | 225100000X | 001558 | CT |
Addresses
Primary practice location
290 Baker Ave.
Suite 111
Concord, MA 01742
Mailing address
18 Notre Dane Rd.
Bedford, MA 01730
Phone (617) 275-1063
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y65099 | Other | MA | BCBS |
Other names 1
- Mary Duffy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120222000802 | MA | Practitioner - Physical Therapist in Private Practice | 4284527433 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001558 | CT | MD | Marriage & Family Therapist |
| 2727 | MA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104851112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 NOTRE DANE RD.",
"city": "BEDFORD",
"state": "MA",
"postal_code": "01730",
"telephone_number": "617-275-1063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "290 BAKER AVE.",
"address_2": "SUITE 111",
"city": "CONCORD",
"state": "MA",
"postal_code": "01742",
"telephone_number": "978-369-0730",
"fax_number": "978-371-7499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUPKUS",
"first_name": "MARY",
"middle_name": "D",
"credential": "PTMPA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "2727",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "001558",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "Y65099",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "DUFFY",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Concord, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.