NPIMap

Organization Active NPI

Olympic Physical Medicine

  • Sports Physical Therapist
  • Stoneham, MA
National Provider Identifier
1255369963
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physical TherapistTaxonomy code 2251S0007X
Legal business name
OLYMPIC PHYSICAL MEDICINE
Practice address
200 Main Street
111
Stoneham, MA 02180-1619
Phone
(617) 666-8800
Fax
(617) 666-4488
NPI assigned
Jun 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Douglas E White, MSPT, LATC, CSCSNPI 1184655458
Title
President
Phone
(617) 666-8800

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Sports Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251S0007X Primary
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X
Athletic TrainerGroup: 193200000X MULTI-SPECIALTY GROUP 2255A2300X

Addresses

Primary practice location

200 Main Street
111
Stoneham, MA 02180-1619

Mailing address

200 Main Street
111
Stoneham, MA 02180-1619
Phone (617) 666-8800

Other identifiers 4

IdentifierTypeStateIssuer
Y61424OtherMABC/BS
0035582OtherMANEIGHBORHOOD HEALTH
AA36064OtherMAHARVARD PILGRIM
2752329OtherMAAETNA

National Provider Directory

National Provider Directory

Locations

355 Middlesex Ave
Wilmington, MA 01887
Phone (617) 666-8800

Practitioners & affiliated clinicians

Practitioners 3

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": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1255369963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MAIN STREET",
            "address_2": "111",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021801619",
            "telephone_number": "617-666-8800",
            "fax_number": "617-666-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MAIN STREET",
            "address_2": "111",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021801619",
            "telephone_number": "617-666-8800",
            "fax_number": "617-666-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC PHYSICAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-666-8800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPT, LATC, CSCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "Y61424",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH",
            "identifier": "0035582",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "AA36064",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2752329",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoneham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.