Provider Demographics
NPI:1497701031
Name:COMMONWEALTH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COMMONWEALTH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-963-1697
Mailing Address - Street 1:999 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3072
Mailing Address - Country:US
Mailing Address - Phone:781-963-1697
Mailing Address - Fax:781-963-5770
Practice Address - Street 1:999 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3072
Practice Address - Country:US
Practice Address - Phone:781-963-1697
Practice Address - Fax:781-963-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6400060OtherUNITED HEALTHCARE
MAAA51230OtherHARVARD PILGRIM HEALTHCAR
MAY61123OtherBLUE CROSS BLUE SHIELD