Mary Poblete, PT, DPT, C/NDT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

18735 Issued in MA

Practice address

4 Militia Dr
Suite 17
Lexington, MA 02421-4737

Phone

(949) 395-7191

NPI assigned

Oct 7, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Healing Smile Pediatric Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Lexington, MA
  • NPI 1255720900
  NPD (past) Authorized official

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412640000000",
    "number": "1255734083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 BEACON ST",
            "address_2": "APARTMENT 2",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021434353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MILITIA DR",
            "address_2": "SUITE 17",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024214737",
            "telephone_number": "949-395-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POBLETE",
        "first_name": "MARY",
        "credential": "PT, DPT, C/NDT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MA",
            "license": "18735",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "33190",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aliki Pishev, LICSW
• Garrett Kevin Piskor, DMD
• Jill Or Planeta, LICSW
• Louise Plesha
• Linda Marie Ploude, MSW
• Ashley Poirier
• Galen Polise, MS, LMHC
• Vanessa Lee Pombo
• Francynne Pomperada
• Melanie Jean Pond, CCC-SLP

• Pediatric Physical Therapist in Lexington, MA
• Providers in Lexington, MA by specialty
• Pediatric Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.