Provider Demographics
NPI:1013990894
Name:STONE, PETER (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CYPRESS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6776
Mailing Address - Country:US
Mailing Address - Phone:781-383-8767
Mailing Address - Fax:781-383-8687
Practice Address - Street 1:235 CYPRESS ST
Practice Address - Street 2:STE 100
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6776
Practice Address - Country:US
Practice Address - Phone:781-383-8767
Practice Address - Fax:781-383-8687
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65391Medicare ID - Type Unspecified