MEDICARE: MRS. NANCY ANNE LEGERE 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
1	225100000X	Physical Therapist	3132	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y68308	OTHER	MA	BC

General Provider Information

NPI Number	:	1588659189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY ANNE LEGERE PT

Provider Business Mailing Address
First Line	:	7 YOUNG ST
Second Line	:
City	:	TEWKSBURY
State	:	MA
Zip	:	01876-3335
Country	:	US
Telephone Number	:	978-658-5664
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 CONCORD AVE
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-1048
Country	:	US
Telephone Number	:	617-864-4200
Fax Number	:	617-491-7368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/08/2007

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