Basic Information
| Provider Information | |||||||||
| NPI: | 1245387018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERETY | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOWARD | ||||||||
| OtherFirstName: | JOANNA | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15 RYE STREET | ||||||||
| Address2: | STE 125 ABILITIES REHABILITATION CENTER, LLC | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036102200 | ||||||||
| FaxNumber: | 6036102202 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CAMBRIDGE STREET | ||||||||
| Address2: | C/O ORTHOPAEDICS PLUS | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018033766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812298011 | ||||||||
| FaxNumber: | 7812298374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 10/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2912 | NH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 19470 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 08Y005403NH01 | 01 | NH | ANTHEM PROVIDER NUMBER | OTHER | 542065286 | 01 | NH | TAX IDENTIFICATION NUMBER | OTHER | 04-3115319 | 01 | MA | TAX ID ORTHOPAEDICS PLUS | OTHER | 626470 | 01 | NH | HPHC PROVIDER NUMBER | OTHER |