Provider Demographics
NPI:1619026879
Name:NORTH SHORE SPORTS MEDICAL CENTER OF DANVERS, LLC
Entity Type:Organization
Organization Name:NORTH SHORE SPORTS MEDICAL CENTER OF DANVERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-777-3220
Mailing Address - Street 1:4 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2567
Mailing Address - Country:US
Mailing Address - Phone:978-777-3220
Mailing Address - Fax:978-774-5883
Practice Address - Street 1:4 STATE ROAD
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-777-3220
Practice Address - Fax:978-774-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA626072OtherHARVARD PILGRIM HEALTHCAR
MA711510OtherTUFTS
MA0000Y65564OtherBLUE CROSS BLUE SHIELD
MA711510OtherTUFTS