NPIMap

Organization Active NPI

Pro Physical Therapy,Inc.

  • Physical Therapy Clinic/Center
  • East Boston, MA
National Provider Identifier
1336312552
Registry record updated Apr 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
757 Issued in MA
Legal business name
PRO PHYSICAL THERAPY,INC.
Practice address
61 Boardman St
East Boston, MA 02128-2601
Phone
(617) 567-8008
Fax
(617) 567-8008
NPI assigned
Apr 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2008

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

Authorized official

Name
Mr. Jonathan Desjardin
Title
President
Phone
(617) 567-8008

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 757 MA
Physical Therapy Clinic/Center 261QP2000X 757 MA Primary

Addresses

Primary practice location

61 Boardman St
East Boston, MA 02128-2601

Mailing address

61 Boardman St
East Boston, MA 02128-2601
Phone (617) 567-8008

National Provider Directory

National Provider Directory

Locations

61 Boardman St
East Boston, MA 02128
Phone (617) 567-8008

NPI Registry JSON

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1336312552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 BOARDMAN ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021282601",
            "telephone_number": "617-567-8008",
            "fax_number": "617-567-8008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 BOARDMAN ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021282601",
            "telephone_number": "617-567-8008",
            "fax_number": "617-567-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO PHYSICAL THERAPY,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2008-04-09",
        "status": "A",
        "authorized_official_last_name": "DESJARDIN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-567-8008",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MA",
            "license": "757",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MA",
            "license": "757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.