Healthcare Provider Details

I. General information

NPI: 1710600093
Provider Name (Legal Business Name): LOWELL PHYSICAL THERAPY 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CHELMSFORD ST
LOWELL MA
01851-4429
US

IV. Provider business mailing address

12 FLORENCE ST
DRACUT MA
01826-3002
US

V. Phone/Fax

Practice location:
  • Phone: 978-455-4320
  • Fax: 978-455-4325
Mailing address:
  • Phone: 617-461-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEROME MACKESY
Title or Position: PTCO
Credential: PT
Phone: 978-455-4320