Healthcare Provider Details

I. General information

NPI: 1659151488
Provider Name (Legal Business Name): NORTHSHORE MOBILITY & WELLNESS CONCIERGE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SWAN ST
BEVERLY MA
01915-3119
US

IV. Provider business mailing address

19 SWAN ST
BEVERLY MA
01915-3119
US

V. Phone/Fax

Practice location:
  • Phone: 703-402-6412
  • Fax:
Mailing address:
  • Phone: 703-402-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHARYN CROZIER HOWARD
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 703-402-6412