Provider Demographics
NPI:1073546594
Name:PHYSICAL THERAPY ASSOC OF CONCORD
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOC OF CONCORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZUPKUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-369-0730
Mailing Address - Street 1:290 BAKER AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-0730
Mailing Address - Fax:978-371-7499
Practice Address - Street 1:290 BAKER AVE
Practice Address - Street 2:STE 111
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-0730
Practice Address - Fax:978-371-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9775161Medicaid
MAY65568OtherBCBS
MA9775161Medicaid