=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912181785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERASPRING PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2007
-----------------------------------------------------
Last Update Date | 12/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49 WALNUT PARK, BUILDING #5
-----------------------------------------------------
City | WELLESLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-237-1185
-----------------------------------------------------
Fax | 781-237-1189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 WALNUT PARK, BUILDING #5
-----------------------------------------------------
City | WELLESLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-237-1185
-----------------------------------------------------
Fax | 781-237-1189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | SUSAN MARIE HOPPER ROBLEDO
-----------------------------------------------------
Credential | MSPT
-----------------------------------------------------
Telephone | 781-237-1185
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 10761
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------