Provider Demographics
NPI:1831134014
Name:THERAFIT 1 AT RIVEREDGE, INC
Entity Type:Organization
Organization Name:THERAFIT 1 AT RIVEREDGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER / DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:978-452-9252
Mailing Address - Street 1:176 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3126
Mailing Address - Country:US
Mailing Address - Phone:978-452-9252
Mailing Address - Fax:978-970-0271
Practice Address - Street 1:176 WALKER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3126
Practice Address - Country:US
Practice Address - Phone:978-452-9252
Practice Address - Fax:978-970-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11098261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA72320OtherCIGNA GROUP ID
MA800542OtherTUFTS PROVIDER ID
MA2008849OtherAETNA GROUP PROVIDER ID
MA604591OtherHARVARD PILGRIM GROUP ID
MAY65537OtherBLUE CROSS ID
MAY65537OtherBLUE CROSS ID
MAPT0032Medicare PIN