Mary Boulos, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA00481400 Issued in NJ

Practice address

18 Sanders PL
Pompton Plains, NJ 07444-1236

Phone

(973) 296-5769

NPI assigned

Jun 17, 2008

Last updated

Nov 3, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Jersey Spine Group LLCGroup PAC ID 5597859884, 24 clinicians

Healthpro Heritage Rehab and Fitness LLCGroup PAC ID 6507832573, 976 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GBIDAD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Saddle River, NJ
  • NPI 1689022295
  Medicare reassignment Care Compare group NPD
• North Jersey Spine Group LLC

  dba Cnso

  • Neurological Surgery Physician
  • Wayne, NJ
  • NPI 1841375300
  Medicare reassignment Care Compare group NPD
• Wycoff-Nelson

  dba Fyzical Therapy and Balance Centers

  • Physical Therapist
  • Wyckoff, NJ
  • NPI 1477245587
  Medicare reassignment NPD
• Healthpro Heritage Rehab & Fitness, LLC

  • Physical Therapist
  • Independence, MO
  • NPI 1871072462
  NPD
• Opt Physical Therapy and Wellness LLC

  • Physical Therapist
  • Oak Ridge, NJ
  • NPI 1659404457
  NPD (past)

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257206400000",
    "number": "1639339245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 SANDERS PL",
            "city": "POMPTON PLAINS",
            "state": "NJ",
            "postal_code": "074441236",
            "telephone_number": "973-296-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 SANDERS PL",
            "city": "POMPTON PLAINS",
            "state": "NJ",
            "postal_code": "074441236",
            "telephone_number": "973-296-5769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULOS",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-17",
        "last_updated": "2009-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00481400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zigmund Paul Bogucki, DDS MSD
• Amy Beth Bolan, PT
• L Michelle Borden, LCSW
• Alixandra Victoria Borst, CNM
• Brittany Boudreau
• Dana Lyn S. Brahms, M.D.
• Ana Melissa Bravo, PTA
• Chelsea Brower, M.D.
• Jaclyn A Brower, DPT
• Mary Elizabeth Bunone, OTR/L

• Physical Therapist in Pompton Plains, NJ
• Providers in Pompton Plains, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; 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.