Healthcare Provider Details

I. General information

NPI: 1285451765
Provider Name (Legal Business Name): FUSION - OSMED MSO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 HIGHLAND AVE
NEEDHAM MA
02492-2615
US

IV. Provider business mailing address

522 AMHERST ST STE 23
NASHUA NH
03063-1019
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-1290
  • Fax:
Mailing address:
  • Phone: 603-880-0448
  • Fax: 603-881-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SANDRA MAE PUNGOT RASTODER
Title or Position: DIRECTOR OF QUALITY ASSURANCE
Credential:
Phone: 603-880-0448