Provider Demographics
NPI:1386865855
Name:C O R E PHYSICAL THERAPY CENTERS
Entity Type:Organization
Organization Name:C O R E PHYSICAL THERAPY CENTERS
Other - Org Name:CANONI CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CANONI
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,MS
Authorized Official - Phone:781-388-0012
Mailing Address - Street 1:388 PLEASANT ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-8143
Mailing Address - Country:US
Mailing Address - Phone:781-388-0012
Mailing Address - Fax:781-388-3312
Practice Address - Street 1:388 PLEASANT ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8143
Practice Address - Country:US
Practice Address - Phone:781-388-0012
Practice Address - Fax:781-388-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA38236OtherHARVARD PROVIDER NUMBER
MAY61381OtherBLUE CROSS GROUP NUMBER
MA3841105OtherAETNA HMO NUMBER
MA7703674OtherAETNA PIN NUMBER
MA820774OtherTUFTS GROUP NUMBER
MAY68659Medicare ID - Type Unspecified