Provider Demographics
NPI:1396227872
Name:ADVANCED ORTHOPEDIC REHABILITATION SPECIALISTS
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC REHABILITATION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:JARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MOTR/L, MTC
Authorized Official - Phone:781-363-6462
Mailing Address - Street 1:52 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1027
Mailing Address - Country:US
Mailing Address - Phone:781-363-6462
Mailing Address - Fax:
Practice Address - Street 1:22 PLEASANT ST STE 3A
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1506
Practice Address - Country:US
Practice Address - Phone:508-857-0389
Practice Address - Fax:508-857-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAOT69884OtherBLUE CROSS BLUE SHIELD
MA0324949Medicaid
MAY68204OtherBLUE CROSS BLUE SHIELD
MA000000037353Medicaid