Provider Demographics
NPI: | 1689620452 |
---|---|
Name: | PHYSICAL THERAPY INNOVATIONS, INC |
Entity Type: | Organization |
Organization Name: | PHYSICAL THERAPY INNOVATIONS, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | COLLEEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FRIESL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 774-696-8309 |
Mailing Address - Street 1: | 489 WASHINGTON STREET |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | AUBURN |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01501-5709 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 508-721-0000 |
Mailing Address - Fax: | 508-721-0100 |
Practice Address - Street 1: | 489 WASHINGTON ST STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | AUBURN |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01501-5709 |
Practice Address - Country: | US |
Practice Address - Phone: | 508-721-0000 |
Practice Address - Fax: | 508-721-0100 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-25 |
Last Update Date: | 2023-07-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
No | 2251C2600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Cardiopulmonary | Group - Single Specialty |
No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Single Specialty |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Single Specialty |
No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Single Specialty |
No | 2251H1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Human Factors | Group - Single Specialty |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Single Specialty |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Single Specialty |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Single Specialty |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 106969 | Other | FIRST HEALTH |
MA | 60147 | Other | AETNA |
MA | 0017444 | Other | NEIGHBORHOOD HEALTH |
MA | 9701371 | Medicaid | |
MA | Y61125 | Other | BCBS |
MA | 110067079A | Medicaid | |
MA | 41138 | Other | FALLON |
MA | 6400212 | Other | UNITED HEALTH |
MA | 79384401 | Other | NETWORK HEALTH |
MA | 626035 | Other | HP |
MA | 612864 | Other | TUFTS |
MA | 6400212 | Other | UNITED |
MA | 425920 | Other | CIGNA |