MEDICARE: ORTHOPEDIC CARE SPECIALISTS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	332	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y61349	OTHER	MA	BC BS GROUP PROVIDER #
3	602587	OTHER	MA	TUFTS GROUP PROVIDER #
4	0013738	OTHER	MA	NHP PT & OT PROVIDER #
5	626575	OTHER	MA	HPHC GROUP PROVIDER #

General Provider Information

NPI Number	:	1982721387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC CARE SPECIALISTS INC.

Provider Business Mailing Address
First Line	:	15 ROCHE BROS WAY
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1000
Country	:	US
Telephone Number	:	781-344-3535
Fax Number	:	781-573-1696

Provider Business Practice Location Address
First Line	:	20 ROCHE BROS WAY UNIT 1
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1030
Country	:	US
Telephone Number	:	781-573-1686
Fax Number	:	781-573-1696

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	SIMON CORNELISSEN
Credential	:	MD
Telephone Number	:	781-344-3535

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	03/22/2018

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