Individual provider Active NPI

Thomas John Maybury, DPT

  • Physical Therapist
  • Saugus, MA
National Provider Identifier
1487170130
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
23117 Issued in MA
Practice address
124 Broadway Ste a
Saugus, MA 01906-1094
Phone
(781) 941-5002
Fax
(781) 813-2006
NPI assigned
Aug 15, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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 23117 MA Primary

Addresses

Primary practice location

124 Broadway Ste a
Saugus, MA 01906-1094

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (866) 370-8206

Other practice location 1

1353 Dorchester Ave
Dorchester, MA 02122-2932
Phone (617) 740-2415

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171013001669 MA Practitioner - Physical Therapist in Private Practice 2365717501 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

124 Broadway
Suite a
Saugus, MA 01906-1094
Phone (781) 941-5002

Merit-based Incentive Payment System (MIPS)

Final score
85.19 of 100Reported as group
Quality
86.04
Improvement activities
40
Cost
76.23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23117MAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Proex Physical Therapy, LLC Physical Therapist CurrentSince Jun 18, 2018 Accepting new patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince May 22, 2023 Accepting new patients
Proex Physical Therapy, LLC CurrentSince Jun 18, 2018 Accepting new patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince May 22, 2023 Accepting new patients
Carl Gustafson LLC Physical Therapist Past Accepting new patients
Competitive Edge Physical Therapy & Sports Training, LLC Physical Therapist Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33377 Collection Ctr Dr
Chicago, IL 60693
Phone (617) 284-9418

101 University Dr
Ste A6
Amherst, MA 01002
Phone (413) 336-5703

284 Trapelo Rd
Belmont, MA 02478
Phone (857) 626-3284

607 Boylston St
Fl 4
Boston, MA 02116
Phone (857) 240-0909

10 High St
Ste 303
Boston, MA 02110
Phone (617) 542-6999

240 Andover St
Unit F
Peabody, MA 01960
Phone (978) 817-3650

124 Broadway
Ste A
Saugus, MA 01906
Phone (781) 813-5002

1016 Paradise Rd
Swampscott, MA 01907
Phone (781) 309-9007

124 Myron St
West Springfield, MA 01089
Phone (413) 781-7538

210 Commerce Way
Ste 120
Portsmouth, NH 03801
Phone (603) 427-8066

576 Broadhollow Rd
Melville, NY 11747

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1487170130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "866-370-8206",
            "fax_number": "517-435-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 BROADWAY STE A",
            "city": "SAUGUS",
            "state": "MA",
            "postal_code": "019061094",
            "telephone_number": "781-941-5002",
            "fax_number": "781-813-2006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1353 Dorchester Ave",
            "address_purpose": "LOCATION",
            "city": "Dorchester",
            "state": "MA",
            "postal_code": "021222932",
            "country_code": "US",
            "telephone_number": "617-740-2415",
            "fax_number": "617-740-2413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAYBURY",
        "first_name": "THOMAS",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-15",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "23117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saugus, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.