IMPACT SPORTS LAB NPI 1922857432

NPI Information

  • NPI: 1922857432
  • Provider Name: IMPACT SPORTS LAB
  • Classification: Clinic/Center - 261QH0100X
  • Specialization: Health Service
  • Entity Type: Organization
  • Address: 220 W CUMMINGS PARK
    WOBURN, MA
    ZIP 01801
  • Phone: (617) 549-6296

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NPI Details

IMPACT SPORTS LAB is a health service clinic center in Woburn, MA. IMPACT SPORTS LAB NPI is 1922857432. The provider is registered as an organization entity type.

The provider's business location address is:

220 W CUMMINGS PARK
WOBURN, MA
ZIP 01801-346
Phone: (617) 549-6296

The provider's authorized official is Ian Carrera .
The authorized official title is Owner and has the following contact phone number (617) 549-6296.

The enumeration date for this NPI number is 5/16/2024 and was last updated on 5/16/2024.

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
1261QH0100XClinic/CenterHealth ServiceYes

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
11285181552MEDICAIDMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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