Provider Demographics
NPI:1497769483
Name:JUMP START PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:JUMP START PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, CSCS, USAW
Authorized Official - Phone:508-647-1633
Mailing Address - Street 1:1 H F BROWN WAY
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3889
Mailing Address - Country:US
Mailing Address - Phone:508-647-1633
Mailing Address - Fax:508-647-1634
Practice Address - Street 1:1 H F BROWN WAY
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3889
Practice Address - Country:US
Practice Address - Phone:508-647-1633
Practice Address - Fax:508-647-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11437261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0186Medicare PIN