Basic Information
| Provider Information | |||||||||
| NPI: | 1346373115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARATHON PHYSICAL THERAPY AND SPORTS MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027662436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082855533 | ||||||||
| FaxNumber: | 5082857977 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024582063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172441990 | ||||||||
| FaxNumber: | 6172441811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCKINNEY | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | LEIGH | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5082855533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MS, PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 274 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 602335 | 01 | MA | TUFTS HEALTH PLAN | OTHER | Y61396 | 01 | MA | BCBS-MA | OTHER | 0033550 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | AA9925 | 01 | MA | HPHC | OTHER | 9729691 | 05 | MA | MEDICAID |