Provider Demographics
NPI:1396150629
Name:BLUE HILLS SPORT & SPINE REHABILITATION, LLC
Entity type:Organization
Organization Name:BLUE HILLS SPORT & SPINE REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA NATARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-388-7272
Mailing Address - Street 1:340 WOOD RD
Mailing Address - Street 2:STE 303
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2401
Mailing Address - Country:US
Mailing Address - Phone:781-535-6053
Mailing Address - Fax:781-535-6056
Practice Address - Street 1:340 WOOD RD
Practice Address - Street 2:STE 303
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2401
Practice Address - Country:US
Practice Address - Phone:781-535-6053
Practice Address - Fax:781-535-6056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE REHABILITATION NETWORK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty