NPIMap

Individual provider Active NPI

Svetlana Mirvoda, RPT

  • Physical Therapist
  • Allston, MA
National Provider Identifier
1720102452
Registry record updated Jul 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10206 Issued in MA
Practice address
20 Linden St Ste 1
Allston, MA 02134-1776
Phone
(617) 787-0030
Fax
(617) 787-0010
NPI assigned
Mar 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2026

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 10206 MA Primary

Addresses

Primary practice location

20 Linden St Ste 1
Allston, MA 02134-1776

Mailing address

3 Terrane Ave
Natick, MA 01760-1706
Phone (508) 545-2305

Other identifiers 2

IdentifierTypeStateIssuer
0305901MedicaidMA
Y68554OtherMAINDIVIDUAL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/data-research/computer-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other Fox Rehab MA LLC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050921000292 MA Practitioner - Physical Therapist in Private Practice 4981638848 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10206MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Current Accepting new patients
Royal Rehab Center, Inc Past Accepting new patients
Back and Balance Rehabilitation Center Physical Therapist Past Accepting new patients

Organizations & group practices 4

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": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783036800000",
    "number": "1720102452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 TERRANE AVE",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017601706",
            "telephone_number": "508-545-2305",
            "fax_number": "508-545-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 LINDEN ST STE 1",
            "city": "ALLSTON",
            "state": "MA",
            "postal_code": "021341776",
            "telephone_number": "617-787-0030",
            "fax_number": "617-787-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRVODA",
        "first_name": "SVETLANA",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2026-07-03",
        "certification_date": "2026-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "10206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0305901",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL",
            "identifier": "Y68554",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/data-research/computer-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "Fox Rehab MA LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "391 Common St",
            "city": "Dedham",
            "state": "MA",
            "country_code": "US",
            "postal_code": "020264055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Allston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2026; 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.