Healthcare Provider Details

I. General information

NPI: 1528060118
Provider Name (Legal Business Name): JOSEPH S O CONNOR PT SCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CROSS ST SUITE 205
PEABODY MA
01960-1670
US

IV. Provider business mailing address

1 MARKET ST 3RD FLOOR
LYNN MA
01901-1011
US

V. Phone/Fax

Practice location:
  • Phone: 978-538-7370
  • Fax: 978-538-7372
Mailing address:
  • Phone: 781-592-0540
  • Fax: 781-592-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: