NPIMap

Organization Active NPI

Mind Body Soul Physical Therapy

  • Home Health Agency
  • Lowell, MA
National Provider Identifier
1326827957
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
MIND BODY SOUL PHYSICAL THERAPY
Practice address
836 Bridge St Apt 16
Lowell, MA 01850-1610
Phone
(716) 425-6625
NPI assigned
Sep 25, 2023
Last updated
Sep 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Authorized official

Name
Dr. Matthew James Penque, PTNPI 1770133381
Title
Owner/Lead Physical Therapist
Phone
(716) 425-6625

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

836 Bridge St Apt 16
Lowell, MA 01850-1610

Mailing address

836 Bridge St Apt 16
Lowell, MA 01850-1610
Phone (716) 425-6625

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1326827957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 BRIDGE ST APT 16",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018501610",
            "telephone_number": "716-425-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 BRIDGE ST APT 16",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018501610",
            "telephone_number": "716-425-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY SOUL PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-23",
        "status": "A",
        "authorized_official_last_name": "PENQUE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER/LEAD PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "716-425-6625",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; 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.