Provider Demographics
NPI:1154443950
Name:SQUIRES, JR, WILLIAM JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:SQUIRES, JR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BANKS ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1931
Mailing Address - Country:US
Mailing Address - Phone:617-846-5609
Mailing Address - Fax:617-539-0025
Practice Address - Street 1:120 BANKS ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1931
Practice Address - Country:US
Practice Address - Phone:617-846-5609
Practice Address - Fax:617-539-0025
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0359114Medicaid
MAY66479OtherBLUECROSSBLUESHIELD
MAUX7425Medicare PIN