Provider Demographics
NPI:1912099961
Name:SPORTS MEDICINE INC.
Entity Type:Organization
Organization Name:SPORTS MEDICINE INC.
Other - Org Name:ORTHOPEDIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:REID
Authorized Official - Middle Name:JEFFRIES
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:413-773-3379
Mailing Address - Street 1:306A HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301
Mailing Address - Country:US
Mailing Address - Phone:413-773-3379
Mailing Address - Fax:413-772-2705
Practice Address - Street 1:306A HIGH STREET
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301
Practice Address - Country:US
Practice Address - Phone:413-773-3379
Practice Address - Fax:413-772-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9750746Medicaid
MAY65552OtherBCBS
MA2837637OtherAETNA
MA15116OtherHEALTH NEW ENGLAND
MA615742OtherHARVARD PILGRIM
MA606146OtherTUFTS
MA20762OtherFALLON
MA754960OtherCONNECTICARE
MA9750746Medicaid