Provider Demographics
NPI:1104035302
Name:PLYMOUTH BAY ORTHOPEDIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PLYMOUTH BAY ORTHOPEDIC ASSOCIATES, INC.
Other - Org Name:PLYMOUTH BAY ORTHOPEDIC & SPORTS THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-934-7292
Mailing Address - Street 1:95 TREMONT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4738
Mailing Address - Country:US
Mailing Address - Phone:781-934-7292
Mailing Address - Fax:781-934-8112
Practice Address - Street 1:41 RESNIK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4842
Practice Address - Country:US
Practice Address - Phone:781-934-7292
Practice Address - Fax:508-746-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2592251X0800X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9764984Medicaid
MAY68336Medicare ID - Type UnspecifiedJAYNE LIPMAN PT
MAB39182Medicare ID - Type UnspecifiedR.S. OLIVER MD
MAPT0111Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY GRP
MA001910201Medicare PIN
MAJ10640Medicare ID - Type UnspecifiedJ.F. ZABILSKI MD
MA1287490001Medicare ID - Type UnspecifiedTHERAPY GROUP DME
MAY6946601Medicare PIN
MAY68844Medicare ID - Type UnspecifiedRAYMOND MALLORY PT
MAA35836Medicare ID - Type UnspecifiedW.G.STANWOOD MD
MAA40161Medicare ID - Type UnspecifiedE.P. RIGHTMIRE MD
MAPT0112Medicare ID - Type UnspecifiedPHYSICAL THERAPY GROUP
MA9764984Medicaid
MA000185701Medicare PIN
MAY68355Medicare ID - Type UnspecifiedCHRISTINE COYNE PT