Provider Demographics
NPI:1871657163
Name:MOUNT HOPE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MOUNT HOPE PHYSICAL THERAPY
Other - Org Name:MOUNT HOPE PHYSICAL & AQUATIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEVES
Authorized Official - Suffix:II
Authorized Official - Credentials:PTA
Authorized Official - Phone:508-379-0090
Mailing Address - Street 1:1738 GRAND ARMY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777
Mailing Address - Country:US
Mailing Address - Phone:508-379-0090
Mailing Address - Fax:508-379-6050
Practice Address - Street 1:1738 GRAND ARMY HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3906
Practice Address - Country:US
Practice Address - Phone:508-379-0090
Practice Address - Fax:508-379-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8384225100000X
MA338261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAVX0303OtherPTAN
MA1942249651OtherNPI (INDIVIDUAL)
MA1871657163OtherNPI (GROUP)
MA1831401405OtherNPI (INDIVIDUAL)
MAVX2642OtherPTAN
MA1100844814AMedicaid
MA1831401405OtherNPI (INDIVIDUAL)
MAPT01808Medicare PIN
MAPT0331Medicare PIN