Healthcare Provider Details

I. General information

NPI: 1588643092
Provider Name (Legal Business Name): MARIE LUCEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 GRAPEVINE RD
WENHAM MA
01984
US

IV. Provider business mailing address

255 GRAPEVINE RD
WENHAM MA
01984
US

V. Phone/Fax

Practice location:
  • Phone: 978-867-4095
  • Fax: 978-867-4680
Mailing address:
  • Phone: 978-867-4095
  • Fax: 978-867-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARIE LUCEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 978-867-4095