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General NPI Number Information
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NPI Number | 1710600093
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Entity Type | Organization
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Legal Business Name | LOWELL PHYSICAL THERAPY 1
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 325 CHELMSFORD ST
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City | LOWELL
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State | MA
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Zip | 01851-4429
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Country | US
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Telephone | 978-455-4320
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Fax | 978-455-4325
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Provider Business Mailing Address
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Address Line | 12 FLORENCE ST
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City | DRACUT
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State | MA
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Zip | 01826-3002
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Country | US
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Telephone | 617-461-8277
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Fax |
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Authorized Official
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Title or Position | PTCO
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Name | JEROME MACKESY
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Credential | PT
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Telephone | 978-455-4320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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