Provider Demographics
NPI:1114913118
Name:SWEET, CONCETTA PHYLLIS (PT, CPUR)
Entity Type:Individual
Prefix:MS
First Name:CONCETTA
Middle Name:PHYLLIS
Last Name:SWEET
Suffix:
Gender:F
Credentials:PT, CPUR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-3718
Mailing Address - Country:US
Mailing Address - Phone:978-851-6126
Mailing Address - Fax:978-858-3603
Practice Address - Street 1:14 DONNA DR
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-3718
Practice Address - Country:US
Practice Address - Phone:978-851-6126
Practice Address - Fax:978-858-3603
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0385603Medicaid
MAY66632OtherBC/BS PROVIDER #
MAY68710Medicare ID - Type Unspecified