Individual provider Active NPI

Jessica Lynn Douglas, MSPT

  • Physical Therapist
  • Boston, MA
National Provider Identifier
1205814076
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
15461 Issued in MA
Practice address
4 Water St
Boston, MA 02109-3503
Phone
(857) 277-0923
Fax
(844) 912-8606
NPI assigned
Jan 3, 2006
Last updated
Oct 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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 15461 MA Primary

Addresses

Primary practice location

4 Water St
Boston, MA 02109-3503

Mailing address

4 Richmond SQ
Providence, RI 02906-5117
Phone (401) 433-4172

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116000613 MA Practitioner - Physical Therapist in Private Practice 3577527902 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Joint Ventures Physical Therapy IncGroup PAC ID 2163474560, 62 clinicians

Practice addresses (Care Compare)

356 3Rd St
Cambridge, MA 02142-1111
Phone 61753611615

4 Water St
Boston, MA 02109-3503
Phone 61753611613

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15461MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Fern Practice, LLC Physical Therapist CurrentSince Jan 1, 2026 Accepting new patients
Joint Ventures Physical Therapy, Inc. Physical Therapist CurrentSince Jan 30, 2006 Accepting new patients
Silver Fern Practice, LLC Physical Therapist CurrentSince Jan 1, 2026 Accepting new patients
Joint Ventures Physical Therapy, Inc. CurrentSince Jan 30, 2006 Accepting new patients

Locations

1395 Commerce Way
Ste 112
Attleboro, MA 02703
Phone (508) 455-5740

4 Water St
Boston, MA 02109
Phone 61753611613

654 Beacon St
Ste 2
Boston, MA 02215
Phone 61753611611

115 Norwood Park S
Norwood, MA 02062
Phone (781) 349-5181

4 Richmond Sq
Providence, RI 02906
Phone (401) 885-2821

4 Richmond Sq
Ste 200
Providence, RI 02906

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1205814076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 RICHMOND SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065117",
            "telephone_number": "401-433-4172",
            "fax_number": "401-433-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 WATER ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021093503",
            "telephone_number": "857-277-0923",
            "fax_number": "844-912-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "MSPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "15461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.