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NPI Code Detail

MEDICARE: NANCY JANE DEMUTH PT

MEDICARE: NANCY JANE DEMUTH PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist6757MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y67689OTHERMABCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376527572
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY JANE DEMUTH PT
Provider Business Mailing Address
First Line : 1 WIDGER RD
Second Line :
City : MARBLEHEAD
State : MA
Zip : 01945-2146
Country : US
Telephone Number : 781-631-8250
Fax Number : 781-639-2060
Provider Business Practice Location Address
First Line : 1 WIDGER RD
Second Line :
City : MARBLEHEAD
State : MA
Zip : 01945-2146
Country : US
Telephone Number : 781-631-8250
Fax Number : 781-639-2060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 07/08/2007

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