Healthcare Provider Details

I. General information

NPI: 1013015528
Provider Name (Legal Business Name): JOHN A. KALOGERIS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BEDFORD ST SUITE 9
LEXINGTON MA
02420-4320
US

IV. Provider business mailing address

35 BEDFORD ST SUITE 9
LEXINGTON MA
02420-4320
US

V. Phone/Fax

Practice location:
  • Phone: 781-863-1801
  • Fax: 781-274-6005
Mailing address:
  • Phone: 781-863-1801
  • Fax: 781-274-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5476
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: