Healthcare Provider Details
I. General information
NPI: 1700865672
Provider Name (Legal Business Name): JOHN J LEWCZYK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 01/10/2006
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
112 HARDING ST
WORCESTER MA
01604-5020
US
IV. Provider business mailing address
5 NEPONSET ST FL ST2
WORCESTER MA
01606-2714
US
V. Phone/Fax
- Phone: 508-964-5592
- Fax: 508-453-8185
- Phone: 508-856-9510
- Fax: 508-853-1907
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | 7090 |
| License Number State | MA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | Y67941 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE CARE ELECT |
| # 2 | |
| Identifier | 2779432 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA HEALTH PLAN |
| # 3 | |
| Identifier | 650017412 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | RAILROAD MEDICARE |
| # 4 | |
| Identifier | Y67941 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE SHIELD HMO BLUE |
| # 5 | |
| Identifier | Y68466 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MEDICARE B |
| # 6 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | ONE HEALTH PLAN |
| # 7 | |
| Identifier | 2779432001 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA PAL ID |
| # 8 | |
| Identifier | 56640 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CHILDRENS MEDICAL SECURIT |
| # 9 | |
| Identifier | 35481155 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA HEALTHSOURCE |
| # 10 | |
| Identifier | 785957 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MVP HEALTH CARE |
| # 11 | |
| Identifier | 43207 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FALLON COMMUNITY HEALTH |
| # 12 | |
| Identifier | 0318949 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MEDICAID WELFARE |
| # 13 | |
| Identifier | 0318949 |
| Identifier Type | MEDICAID |
| Identifier State | MA |
| Identifier Issuer | |
| # 14 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTHCARE VALUE MANAGEME |
| # 15 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PRIVATE HEALTHCARE SYSTEM |
| # 16 | |
| Identifier | 7199625 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA US HEALTHCARE |
| # 17 | |
| Identifier | AA4052 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HARVARD PILGRIM HEALTHCAR |
| # 18 | |
| Identifier | 042472266 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | THREE RIVERS |
| # 19 | |
| Identifier | Y67941 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE SHIELD INDEMNITY |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
