Provider Demographics
NPI:1235520453
Name:HEALTHY SOLES
Entity Type:Organization
Organization Name:HEALTHY SOLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, OCS, CSCS
Authorized Official - Phone:617-869-9986
Mailing Address - Street 1:100 JERSEY ST
Mailing Address - Street 2:APT #103
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4811
Mailing Address - Country:US
Mailing Address - Phone:617-869-9986
Mailing Address - Fax:617-395-2697
Practice Address - Street 1:581 BOYLSTON ST
Practice Address - Street 2:SUITE 504A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3608
Practice Address - Country:US
Practice Address - Phone:617-869-9986
Practice Address - Fax:617-395-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16185261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1063491587OtherNPI