OUTBACK PHYSICAL THERAPY, INC. (NPI# 1114272515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114272515 |
| Entity Type | Organization |
| Organization Name | OUTBACK PHYSICAL THERAPY, INC. |
| Other Organization Name | OUTBACK PHYSICAL THERAPY |
| Practice Address |
149a Highland Ave Somerville MA 02143-1650 |
| Practice Telephone | 6177089300 |
| Practice Fax Number | 6177189303 |
| Mailing Telephone | 6177189300 |
| Mailing Fax Number | 6177189303 |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2013-05-29 |
| Authorized Official Name | THOMAS JACOB JOTKOWITZ (PRESIDENT) |
| Authorized Official Telephone | 6177189300 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Outback Physical Therapy | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | OUTBACK PHYSICAL THERAPY, INC. | 149a Highland Ave, Somerville, MA 02143 |
| Street Address |
149A HIGHLAND AVE |
| City | SOMERVILLE |
| State | MA |
| Zip Code | 02143-1650 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245843598 | Sidney Marie Joines | Counselor | New Washington St, Somerville, MA 02143 | 2020-08-26 |
| 1487295887 | Tejasvini Goud Jangam | Dentist | 14 Mcgrath Highway Twin City Plaza, Somerville, MA 02143 | 2019-10-07 |
| 1265900658 | Latoya Lewis | Massage Therapist | 343 Medford Street Suite 4b, Somerville, MA 02143 | 2018-11-05 |
| 1982181053 | Robert Lafollette | Social Worker | 61 Inner Belt Rd, Somerville, MA 02143 | 2018-07-23 |
| 1013405471 | Roseli De Fatima Schimanski | Acupuncturist | 10 Clark St #3, Somerville, MA 02143 | 2018-05-01 |
| 1255840070 | Maggie Kinser | Counselor | 366 Somerville Avenue, Somerville, MA 02143 | 2017-09-25 |
| 1497273742 | Isabelle Hackett | Social Worker | 17 Inner Belt Rd, Somerville, MA 02143 | 2017-09-07 |
| 1952824666 | Manuel Cantu | Counselor | 17 Inner Belt Road, Somerville, MA 02143 | 2017-07-25 |
| 1649710963 | Shakemia Shaw | Licensed Practical Nurse | 230 Highland Avenue, Somerville, MA 02143 | 2017-03-06 |
| 1245600501 | Libby Vilner | Social Worker | 12 Tyler St., Somerville, MA 02143 | 2015-09-30 |
| Find all providers in zip 02143 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164925475 | Kerri L O'connor | Clinic/Center | 20 W Spring St, Somerville, NJ 08876-1628 | 2018-03-13 |
| 1699297093 | Trinity Rehab Somerset Pa | Clinic/Center | 89 Us Highway 206, Somerville, NJ 08876-4102 | 2017-07-07 |
| 1487017992 | Matthew Natanson | Clinic/Center | 26 Gordon Street, Somerville, MA 02144-1110 | 2016-04-01 |
| 1174997514 | Encore Rehabilitation Inc | Clinic/Center | 59 Eva Rd, Somerville, AL 35670-6423 | 2015-11-23 |
| 1700320231 | Therazone Physical Therapy LLC | Clinic/Center | 884 Us Highway 22, Somerville, NJ 08876-1560 | 2016-12-19 |
| 1710241088 | Probody Physical Therapy, LLC | Clinic/Center | 265 Medford St, Suite 303, Somerville, MA 02143-1963 | 2012-07-01 |
| 1831479997 | Cambridge Health Alliance | Clinic/Center | 5 Middlesex Ave, Somerville, MA 02145-1102 | 2011-08-22 |
| 1528363116 | Step Ahead Physical Therapy | Clinic/Center | 5 Middlesex Ave, Suite 203, Somerville, MA 02145-1102 | 2011-01-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013518448 | Shira Lauren Dragun | Clinic/Center | 63 1/2 Jefferson Ave, Salem, MA 01970-2975 | 2020-11-03 |
| 1518564566 | Ann Pappas Physical Therapy | Clinic/Center | 470 Washington St Ste 31, Norwood, MA 02062-2343 | 2020-10-02 |
| 1538786272 | Neurologic Optimal Wellness Physical Therapy LLC | Clinic/Center | 180 King St, Springfield, MA 01109-4316 | 2020-06-29 |
| 1689297525 | Full Spectrum Physical Therapy and Performance, LLC | Clinic/Center | 17 Cannongate Rd Apt 83, Tyngsboro, MA 01879-1413 | 2020-05-27 |
| 1992328421 | Adam Auto Accident Physio Doctor,inc | Clinic/Center | 1011 Beacon St Ste 1, Brookline, MA 02446-5696 | 2020-05-19 |
| 1952938839 | Jessica Moy Wellness LLC | Clinic/Center | 255 Massachusetts Ave Apt 204, Boston, MA 02115-3511 | 2020-03-23 |
| 1598390940 | The Method Performance and Physical Therapy LLC | Clinic/Center | 378 North St Apt 2, Boston, MA 02113-2143 | 2020-03-05 |
| 1104458785 | Olender Physical Therapy, LLC | Clinic/Center | 316 Washington St Ste 1, Wellesley, MA 02481-4959 | 2020-02-11 |
| 1851930028 | Core Physical Therapy & Performance, LLC | Clinic/Center | 11 Randolph Rd, Randolph, MA 02368-4321 | 2020-01-05 |
| 1316585482 | Healthworks Med Group of Massachusetts P C | Clinic/Center | 157 Berkeley St, Boston, MA 02116-5108 | 2019-12-19 |
| Find all providers with the same taxonomy | ||||
| City | SOMERVILLE |
| Zip Code | 02143 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.