Provider Demographics
NPI:1134292998
Name:JOTKOWITZ, THOMAS J (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:JOTKOWITZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ITHAMAR
Other - Middle Name:J
Other - Last Name:JOTKOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:149A HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143
Mailing Address - Country:US
Mailing Address - Phone:617-718-9300
Mailing Address - Fax:617-718-9303
Practice Address - Street 1:149A HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143
Practice Address - Country:US
Practice Address - Phone:617-708-9300
Practice Address - Fax:617-718-9303
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027924-1225100000X
MA19343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ31Z8QA561Medicare PIN