Active NPI
Alex John Petruska Jr., PT
- Sports Physical Therapist
- Boston, MA
National Provider Identifier
1912930819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physical Therapist
- License
- 2874
- Practice address
- 175 Cambridge St
Suite 470
Boston, MA 02114-2743 - Phone
- (617) 643-0912
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | 2874 | MA | Primary |
Addresses
Primary practice location
175 Cambridge St
Suite 470
Boston, MA 02114-2743
Mailing address
175 Cambridge St
Suite 470
Boston, MA 02114-2743
Phone (617) 643-0912
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2874 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912930819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 CAMBRIDGE ST",
"address_2": "SUITE 470",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142743",
"telephone_number": "617-643-0912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 CAMBRIDGE ST",
"address_2": "SUITE 470",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142743",
"telephone_number": "617-643-0912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUSKA",
"first_name": "ALEX",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "MA",
"license": "2874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.