Provider Demographics
NPI:1104839638
Name:WOBURN PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:WOBURN PHYSICAL THERAPY, INC
Other - Org Name:PHYSICAL THERAPY OF WOBURN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRE
Authorized Official - Middle Name:
Authorized Official - Last Name:XINTAROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:781-727-8897
Mailing Address - Street 1:400 W CUMMINGS PARK STE 1400
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-7232
Mailing Address - Country:US
Mailing Address - Phone:781-938-1223
Mailing Address - Fax:781-938-1226
Practice Address - Street 1:400 W CUMMINGS PARK STE 1400
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7232
Practice Address - Country:US
Practice Address - Phone:781-938-1223
Practice Address - Fax:781-938-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA70524OtherHARVARD PILGRIM
MA0040567OtherALLWAYS
MA000000193213OtherBMC
MA002697430OtherUNITED
MAV35856OtherTUFTS
MAY61478OtherBLUE CROSS BLUE SHIELD