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NPI Code Detail

MEDICARE: WILLIAM JOSEPH SQUIRES, JR P.T.

MEDICARE:   WILLIAM JOSEPH SQUIRES, JR  P.T.
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
1225100000XPhysical Therapist5028MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2Y66479OTHERMABLUECROSSBLUESHIELD

General Provider Information

NPI Number : 1154443950
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM JOSEPH SQUIRES, JR P.T.
Provider Business Mailing Address
First Line : 120 BANKS ST
Second Line :
City : WINTHROP
State : MA
Zip : 02152-1931
Country : US
Telephone Number : 617-846-5609
Fax Number : 617-539-0025
Provider Business Practice Location Address
First Line : 120 BANKS ST
Second Line :
City : WINTHROP
State : MA
Zip : 02152-1931
Country : US
Telephone Number : 617-846-5609
Fax Number : 617-539-0025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 12/12/2007

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Directions to “ WILLIAM JOSEPH SQUIRES, JR P.T.” Practice Location

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