Provider Demographics
NPI:1912181785
Name:THERASPRING PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:THERASPRING PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOPPER ROBLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:781-237-1185
Mailing Address - Street 1:49 WALNUT PARK, BUILDING #5
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-237-1185
Mailing Address - Fax:781-237-1189
Practice Address - Street 1:49 WALNUT PARK, BUILDING #5
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-237-1185
Practice Address - Fax:781-237-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10761261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARO-Y69725Medicare PIN