Healthcare Provider Details

I. General information

NPI: 1891603239
Provider Name (Legal Business Name): ARTHUR DE MOURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 MORRISSEY BLVD
DORCHESTER MA
02122-3242
US

IV. Provider business mailing address

960 MORRISSEY BLVD
DORCHESTER MA
02122-3242
US

V. Phone/Fax

Practice location:
  • Phone: 617-506-7210
  • Fax:
Mailing address:
  • Phone: 617-506-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number89518
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: