Active NPI
Erin Brooke Donnelly, PT, DPT, ATC
- Physical Therapist
- Medford, MA
National Provider Identifier
1962058289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 24520
- Practice address
- 161 College Ave
Medford, MA 02155-5593 - Phone
- (781) 874-9748
- Fax
- (617) 627-2185
- NPI assigned
- Aug 13, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 24520 | MA | Primary |
Addresses
Primary practice location
161 College Ave
Medford, MA 02155-5593
Mailing address
161 College Ave
Medford, MA 02155-5593
Phone (781) 874-9748
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 |
|---|---|---|---|
| 24520 | MA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ortho & Sports Physical Therapy | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapy Clinic/Center
- Boston, MA
- NPI 1700864139
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1962058289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "161 COLLEGE AVE",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555593",
"telephone_number": "781-874-9748",
"fax_number": "617-627-2185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161 COLLEGE AVE",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555593",
"telephone_number": "781-874-9748",
"fax_number": "617-627-2185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONNELLY",
"first_name": "ERIN",
"middle_name": "BROOKE",
"credential": "PT, DPT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-13",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "24520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.