Healthcare Provider Details

I. General information

NPI: 1831973734
Provider Name (Legal Business Name): UNION SQUARE PHYSICAL THERAPY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SOMERVILLE AVE
SOMERVILLE MA
02143-3257
US

IV. Provider business mailing address

71 WICKLOW AVE
MEDFORD MA
02155-2825
US

V. Phone/Fax

Practice location:
  • Phone: 860-899-9652
  • Fax:
Mailing address:
  • Phone: 860-899-9652
  • 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 Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MAEGEN BRADY DELEO
Title or Position: OWNER
Credential:
Phone: 860-899-9652