MEDICARE: MR. ROBERT D JEAN ATC

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	225200000X	Physical Therapy Assistant	2131	MA
2	2255A2300X	Athletic Trainer	597	MA

General Provider Information

NPI Number	:	1699749325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT D JEAN ATC

Provider Business Mailing Address
First Line	:	18 COLONIAL RD
Second Line	:
City	:	PEABODY
State	:	MA
Zip	:	01960-1810
Country	:	US
Telephone Number	:	978-532-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 HIGHLAND AVE
Second Line	:	SUITE 201
City	:	SALEM
State	:	MA
Zip	:	01970-2727
Country	:	US
Telephone Number	:	978-741-0880
Fax Number	:	978-740-5595

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	09/11/2025

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