Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 225100000X | Physical Therapist | | 13285 | MASSACHUSETTS | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 2 | 2779432 | OTHER | | CIGNA HEALTH PLAN |
| 3 | 785968 | OTHER | | MVP HEALTH CARE |
| 4 | Y37676 | OTHER | | BLUE CARE ELECT |
| 5 | Y37676 | OTHER | | BLUE SHIELD HMO BLUE |
| 6 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 7 | 2779432001 | OTHER | | CIGNA PAL ID |
| 8 | 47830 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 9 | Y68495 | OTHER | | MEDICARE B |
| 10 | 0396290 | OTHER | | MEDICAID WELFARE |
| 11 | 7793634 | OTHER | | AETNA US HEALTHCARE |
| 12 | 61610 | OTHER | | FALLON COMMUNITY HEALTH P |
| 13 | 0396290 | MEDICAID | MASSACHUSETTS | |
| 14 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 15 | 042472266 | OTHER | | THREE RIVERS |
| 16 | AA4052 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 17 | 35481155 | OTHER | | CIGNA HEALTHSOURCE |
| 18 | 650026059 | OTHER | | RAILROAD MEDICARE |
| 19 | Y37676 | OTHER | | BLUE SHIELD INDEMNITY |
