Provider Demographics
NPI:1922134816
Name:NEW ENGLAND SPORTS THERAPY PLUS III, INC
Entity Type:Organization
Organization Name:NEW ENGLAND SPORTS THERAPY PLUS III, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORREIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-341-2224
Mailing Address - Street 1:966A PARK ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3650
Mailing Address - Country:US
Mailing Address - Phone:781-341-2224
Mailing Address - Fax:781-341-5915
Practice Address - Street 1:142 PARK ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1228
Practice Address - Country:US
Practice Address - Phone:617-265-2224
Practice Address - Fax:617-822-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9756281Medicaid