Provider Demographics
NPI:1154355725
Name:MASS BAY SPINE & SPORT PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:MASS BAY SPINE & SPORT PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC
Authorized Official - Phone:781-319-0024
Mailing Address - Street 1:506 PLAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2744
Mailing Address - Country:US
Mailing Address - Phone:781-319-0024
Mailing Address - Fax:781-319-0088
Practice Address - Street 1:506 PLAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2744
Practice Address - Country:US
Practice Address - Phone:781-319-0024
Practice Address - Fax:781-319-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA40694OtherHARVARD PILGRIM HEALTHCAR
MAY61429OtherBCBS
MA441368OtherTUFTS HEALTHPLAN
MAPT0291Medicare PIN