Matthew J Penque

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

24298 Issued in MA

Practice address

413 Trapelo Rd # 2
Belmont, MA 02478-1417

Phone

(617) 932-1027

Fax

(617) 932-1476

NPI assigned

Sep 16, 2019

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Mind Body Soul Physical Therapy

  • Home Health Agency
  • Lowell, MA
  • NPI 1326827957
  NPD Authorized official

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

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568937600000",
    "number": "1770133381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 COLLEGE RD",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "017421526",
            "telephone_number": "617-932-1027",
            "fax_number": "617-932-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 TRAPELO RD # 2",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024781417",
            "telephone_number": "617-932-1027",
            "fax_number": "617-932-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENQUE",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-16",
        "last_updated": "2019-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "24298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Laura Payne, LICSW
• Mary Pederson Metelmann, LICSW
• Holly Samantha Peek, M.D.
• Michael Rocco Pellegrini, D.M.D.
• Cynthia Peng, MD
• Rebecca Lea Perkins, DMD, MMSC
• Sara Lea Perkins, DMD
• Keely Petri, LICSW
• Kelly Phelps, PSY.D.
• Kathryn Phillips, NP

• Physical Therapist in Belmont, MA
• Providers in Belmont, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.