Healthcare Provider Details

I. General information

NPI: 1407833718
Provider Name (Legal Business Name): LOUIS B. COIRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 MAIN ST UNIT 4
TEWKSBURY MA
01876-1800
US

IV. Provider business mailing address

885 MAIN ST UNIT #4
TEWKSBURY MA
01876-1800
US

V. Phone/Fax

Practice location:
  • Phone: 978-851-8768
  • Fax: 978-851-8606
Mailing address:
  • Phone: 978-851-8768
  • Fax: 978-851-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA BLUTE
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 978-851-8768