Provider Demographics
NPI:1104851112
Name:ZUPKUS, MARY D (PTMPA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:ZUPKUS
Suffix:
Gender:F
Credentials:PTMPA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18 NOTRE DANE RD.
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730
Mailing Address - Country:US
Mailing Address - Phone:617-275-1063
Mailing Address - Fax:
Practice Address - Street 1:290 BAKER AVE.
Practice Address - Street 2:SUITE 111
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-0730
Practice Address - Fax:978-371-7499
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2727225100000X
CT001558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65099OtherBCBS
MAY65099Medicare ID - Type Unspecified