Individual provider Active NPI

Michael Bove, PT

  • Physical Therapist
  • Tewksbury, MA
National Provider Identifier
1790734424
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7509 Issued in MA
Practice address
885 Main St
Unit 4
Tewksbury, MA 01876-1800
Phone
(978) 851-8768
Fax
(978) 851-8606
NPI assigned
May 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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 7509 MA Primary

Addresses

Primary practice location

885 Main St
Unit 4
Tewksbury, MA 01876-1800

Mailing address

885 Main St
Unit 4
Tewksbury, MA 01876-1800
Phone (978) 851-8768

Other identifiers 1

IdentifierTypeStateIssuer
0368059MedicaidMA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060417000396 MA Practitioner - Physical Therapist in Private Practice 2365451531 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bay State Physical Therapy of Randolph IncGroup PAC ID 6305744251, 451 clinicians

Practice addresses (Care Compare)

1343 Boston Providence Tpke
Norwood, MA 02062-5055
Phone (781) 702-1339

1830 Main St
Apt 1
Tewksbury, MA 01876-4712
Phone (978) 710-6254

400 W Cummings Park
Suite 1800
Woburn, MA 01801-6505
Phone (781) 995-0064

703 Granite St
Suite 300
Braintree, MA 02184-5350
Phone (781) 961-3370

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7509MAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Bay State Physical Therapy of Randolph Inc CurrentSince Jan 1, 2025 Accepting new patients
Bay State Physical Therapy of Randolph Inc Physical Therapist CurrentSince Jan 1, 2025 Accepting new patients

Locations

1343 Providence Hwy
Norwood, MA 02062
Phone (781) 702-1339

885 Main St
Ste 4
Tewksbury, MA 01876
Phone (978) 851-8766

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": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1790734424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 MAIN ST",
            "address_2": "UNIT 4",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "018761800",
            "telephone_number": "978-851-8768",
            "fax_number": "978-851-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 MAIN ST",
            "address_2": "UNIT 4",
            "city": "TEWKSBURY",
            "state": "MA",
            "postal_code": "018761800",
            "telephone_number": "978-851-8768",
            "fax_number": "978-851-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOVE",
        "first_name": "MICHAEL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "7509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0368059",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tewksbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; 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.