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General NPI Number Information
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NPI Number | 1063901569
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Entity Type | Individual
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Provider Name | JASON LUNDMARK DPT
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Gender | Male
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 231 CHIEF JUSTICE CUSHING HWY STE 203
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City | COHASSET
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State | MA
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Zip | 02025-1383
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Country | US
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Telephone | 781-214-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 264 BROOK CIR
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City | HANOVER
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State | MA
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Zip | 02339-1877
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Country | US
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Telephone | 716-969-2979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22980
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License Number State | MA
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