Healthcare Provider Details

I. General information

NPI: 1649057480
Provider Name (Legal Business Name): JESSE LIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 NORTH RD
SUDBURY MA
01776-1142
US

IV. Provider business mailing address

4 RICHMOND SQ
PROVIDENCE RI
02906-5117
US

V. Phone/Fax

Practice location:
  • Phone: 978-393-8778
  • Fax: 978-393-8393
Mailing address:
  • Phone: 401-433-4172
  • Fax: 401-433-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL27102
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: