Provider Demographics
NPI:1922198324
Name:MOUNT AUBURN PHYSICAL THERAPY ASSOCIATES, PC
Entity Type:Organization
Organization Name:MOUNT AUBURN PHYSICAL THERAPY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LATTANZI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-923-0757
Mailing Address - Street 1:521 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4191
Mailing Address - Country:US
Mailing Address - Phone:617-923-0757
Mailing Address - Fax:617-923-2127
Practice Address - Street 1:521 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4191
Practice Address - Country:US
Practice Address - Phone:617-923-0757
Practice Address - Fax:617-923-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61017OtherBC/BS
MAPT0034Medicare ID - Type Unspecified