Provider Demographics
NPI:1154525525
Name:NEW ENGLAND ORTHOPEDICS PHYSICAL THERAPY
Entity type:Organization
Organization Name:NEW ENGLAND ORTHOPEDICS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-785-4666
Mailing Address - Street 1:300 BIRNIE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1107
Mailing Address - Country:US
Mailing Address - Phone:413-785-4666
Mailing Address - Fax:
Practice Address - Street 1:300 BIRNIE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1107
Practice Address - Country:US
Practice Address - Phone:413-785-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2438612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========OtherTAX ID