NPIMap

Individual provider Active NPI

Elena Emilie Brousseau, PT

  • Physical Therapist
  • Malden, MA
National Provider Identifier
1306957022
Registry record updated Mar 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8650 Issued in MA
Practice address
350 Main St
Commerce Place McGovern PT
Malden, MA 02148-5089
Phone
(781) 321-2727
Fax
(781) 321-4995
NPI assigned
Aug 31, 2006
Last updated
Mar 22, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2013

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 8650 MA Primary

Addresses

Primary practice location

350 Main St
Commerce Place McGovern PT
Malden, MA 02148-5089

Mailing address

350 Main Street
Commerce Place McGovern PT
Malden, MA 02148
Phone (781) 321-2727

Other names 1

  • Elena Emilie Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8650MAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
McGovern Physical Therapy Associates LLC Physical Therapist Past Accepting new patients
North Suburban Orthopedic Associates, Inc. Past Accepting new patients
Dr Jennifer S Wu PC Past Accepting new patients
Byron V Hartunian MD PC Past Accepting new patients
North Suburban Orthopedic Associates Inc Physical Therapist Past Accepting new patients
Orthopedic Surgery, Inc Past Accepting new patients

Organizations & group practices 6

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363910400000",
    "number": "1306957022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 MAIN STREET",
            "address_2": "COMMERCE PLACE MCGOVERN PT",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "02148",
            "telephone_number": "781-321-2727",
            "fax_number": "781-321-4995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 MAIN ST",
            "address_2": "COMMERCE PLACE MCGOVERN PT",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485089",
            "telephone_number": "781-321-2727",
            "fax_number": "781-321-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSEAU",
        "first_name": "ELENA",
        "middle_name": "EMILIE",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "8650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELENA",
            "last_name": "JOHNSON",
            "middle_name": "EMILIE",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Malden, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; 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.