NPIMap

Organization Active NPI

Beantown Physio, Inc

  • Physical Therapist
  • Brookline, MA
National Provider Identifier
1477547529
Registry record updated Oct 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
16266 Issued in MA
Legal business name
BEANTOWN PHYSIO, INC
Practice address
33 Pond Ave
Suite 107B
Brookline, MA 02445-7163
Phone
(617) 232-7246
Fax
(617) 232-5196
NPI assigned
Sep 6, 2005
Last updated
Oct 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2011

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

Authorized official

Name
Paul M Ghostlaw, PTNPI 1437110582
Title
President/ Physical Therpist
Phone
(617) 232-7246

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
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 16266 MA Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 8336 MA

Addresses

Primary practice location

33 Pond Ave
Suite 107B
Brookline, MA 02445-7163

Mailing address

33 Pond Ave
Suite 107B
Brookline, MA 02445-7163
Phone (617) 232-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040825000295 MA Part B Supplier - Clinic/Group Practice 0749254746 Receives reassigned benefits from 8 practitioners
Practice locations: Brookline, MA; West Roxbury, MA

National Provider Directory

National Provider Directory

Locations

1208B Vfw Pkwy
Ste 202
West Roxbury, MA 02132
Phone (617) 325-7246

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318896000000",
    "number": "1477547529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 POND AVE",
            "address_2": "SUITE 107B",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024457163",
            "telephone_number": "617-232-7246",
            "fax_number": "617-232-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 POND AVE",
            "address_2": "SUITE 107B",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024457163",
            "telephone_number": "617-232-7246",
            "fax_number": "617-232-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEANTOWN PHYSIO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2011-10-18",
        "status": "A",
        "authorized_official_last_name": "GHOSTLAW",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/ PHYSICAL THERPIST",
        "authorized_official_telephone_number": "617-232-7246",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "16266",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "8336",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookline, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.