NPIMap

Organization Active NPI

Wells Physical Therapy & Associates

Doing business as Broadway Physical Therapy & Rehab

  • Physical Therapy Clinic/Center
  • Revere, MA
National Provider Identifier
1679118632
Registry record updated May 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
WELLS PHYSICAL THERAPY & ASSOCIATES
Doing business as
Broadway Physical Therapy & Rehab
Practice address
185 Squire Rd
Revere, MA 02151-1234
Phone
(781) 284-0559
Fax
(781) 284-0698
NPI assigned
Nov 14, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2020

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

Authorized official

Name
Mr. Thomas W WellsNPI 1225268006
Title
Owner
Phone
(781) 284-0559

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

185 Squire Rd
Revere, MA 02151-1234

Mailing address

185 Squire Rd
Revere, MA 02151-1234
Phone (781) 284-0559

Other names 1

  • Broadway Physical Therapy & Rehab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200914002527 MA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8325466915 Receives reassigned benefits from 2 practitioners
Practice locations: Revere, MA

National Provider Directory

National Provider Directory

Locations

185 Squire Rd
Revere, MA 02151
Phone (781) 284-0559

Practitioners & affiliated clinicians

Practitioners 3

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": "1573689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1679118632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 SQUIRE RD",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021511234",
            "telephone_number": "781-284-0559",
            "fax_number": "781-284-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 SQUIRE RD",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021511234",
            "telephone_number": "781-284-0559",
            "fax_number": "781-284-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLS PHYSICAL THERAPY & ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-14",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-284-0559",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Physical Therapy & Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Broadway Physical Therapy & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Revere, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.