NPIMap

Organization Active NPI

Lakeville Physical Therapy Inc

  • Physical Therapist
  • Lakeville, MA
National Provider Identifier
1497951594
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5869 Issued in MA
Legal business name
LAKEVILLE PHYSICAL THERAPY INC
Practice address
155 Millennium Cir
Suite 114
Lakeville, MA 02347
Phone
(508) 947-3004
Fax
(508) 923-6008
NPI assigned
Jun 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Stephen Givinal Gouveia, PHYSICAL THERAPISTNPI 1154479582
Title
President
Phone
(508) 947-3004

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 5869 MA Primary

Addresses

Primary practice location

155 Millennium Cir
Suite 114
Lakeville, MA 02347

Mailing address

155 Millennium Cir
Suite 114
Lakeville, MA 02347
Phone (508) 947-3004

Other identifiers 3

IdentifierTypeStateIssuer
AA20786OtherMAHPHC
9739190MedicaidMA
Y61391OtherMABCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050607000670 MA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8921041344 Receives reassigned benefits from 1 practitioner
Practice locations: Lakeville, MA

National Provider Directory

National Provider Directory

Locations

155 Millenium Cir
Ste 114
Lakeville, MA 02347
Phone (508) 947-3004

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1497951594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 MILLENNIUM CIR",
            "address_2": "SUITE 114",
            "city": "LAKEVILLE",
            "state": "MA",
            "postal_code": "02347",
            "telephone_number": "508-947-3004",
            "fax_number": "508-923-6008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 MILLENNIUM CIR",
            "address_2": "SUITE 114",
            "city": "LAKEVILLE",
            "state": "MA",
            "postal_code": "02347",
            "telephone_number": "508-947-3004",
            "fax_number": "508-923-6008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVILLE PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "GOUVEIA",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "GIVINAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-947-3004",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "5869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPHC",
            "identifier": "AA20786",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9739190",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y61391",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.