NPIMap

Organization Active NPI

Advanced Sports Therapy, LLC

  • Physical Therapist
  • Wellesley, MA
National Provider Identifier
1245772839
Registry record updated Dec 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ADVANCED SPORTS THERAPY, LLC
Practice address
62 Walnut St
Wellesley, MA 02481-2113
Phone
(781) 235-5275
Fax
(781) 235-5276
NPI assigned
Nov 14, 2016
Last updated
Dec 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2016

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

Authorized official

Name
Matthew PenneyNPI 1043291198
Title
President
Phone
(781) 235-5275

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 Therapist 225100000X Primary

Addresses

Primary practice location

62 Walnut St
Wellesley, MA 02481-2113

Mailing address

62 Walnut St
Wellesley, MA 02481-2113
Phone (781) 235-5275

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161207001149 MA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9133409238 Receives reassigned benefits from 10 practitioners
Practice locations: Wellesley, MA

National Provider Directory

National Provider Directory

Locations

62 Walnut St
Wellesley Hills, MA 02481
Phone (781) 235-5275

Practitioners & affiliated clinicians

Practitioners 10

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": "1479081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480896000000",
    "number": "1245772839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 WALNUT ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024812113",
            "telephone_number": "781-235-5275",
            "fax_number": "781-235-5276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 WALNUT ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024812113",
            "telephone_number": "781-235-5275",
            "fax_number": "781-235-5276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SPORTS THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-14",
        "last_updated": "2016-12-05",
        "status": "A",
        "authorized_official_last_name": "PENNEY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-235-5275"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellesley, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.