NPIMap

Organization Active NPI

Athletic Edge Physical Therapy

  • Physical Therapy Clinic/Center
  • Woburn, MA
National Provider Identifier
1578052650
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ATHLETIC EDGE PHYSICAL THERAPY
Practice address
7 Alfred St Ste 110
Woburn, MA 01801-1900
Phone
(508) 596-8605
NPI assigned
May 4, 2018
Last updated
Feb 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
Mark Baldwin, PTNPI 1255304291
Title
Owner
Phone
(508) 596-8605

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 Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

7 Alfred St Ste 110
Woburn, MA 01801-1900

Mailing address

83 Greenwood St
Wakefield, MA 01880-4034

Other practice location 1

44 Park St Fl 3
Andover, MA 01810-3684
Phone (978) 409-2380

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180808003502 MA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0042568990 Receives reassigned benefits from 12 practitioners
Practice locations: Woburn, MA; Peabody, MA; Andover, MA

National Provider Directory

National Provider Directory

Locations

44 Park St
Fl 3
Andover, MA 01810
Phone (978) 247-8933

595 Chickering Rd
North Andover, MA 01845
Phone (603) 427-8066

100 Corporate Pl
Ste 204
Peabody, MA 01960
Phone (978) 962-3219

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1578052650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 GREENWOOD ST",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018804034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 ALFRED ST STE 110",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011900",
            "telephone_number": "508-596-8605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44 Park St Fl 3",
            "address_purpose": "LOCATION",
            "city": "Andover",
            "state": "MA",
            "postal_code": "018103684",
            "country_code": "US",
            "telephone_number": "978-409-2380",
            "fax_number": "978-409-2670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ATHLETIC EDGE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-04",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "BALDWIN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-596-8605",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.