Provider Demographics
NPI:1548463581
Name:EVERETT REHABILITATION SERVICES LLC
Entity type:Organization
Organization Name:EVERETT REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPINITO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-389-0359
Mailing Address - Street 1:PO BOX 490953
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-0016
Mailing Address - Country:US
Mailing Address - Phone:617-389-0359
Mailing Address - Fax:617-389-4031
Practice Address - Street 1:563 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3749
Practice Address - Country:US
Practice Address - Phone:617-389-0359
Practice Address - Fax:617-389-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61295OtherBLUE CROSS