Provider Demographics
NPI:1164533881
Name:DOUZEPIS, JOHN PETROS (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PETROS
Last Name:DOUZEPIS
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 1:405 PEARL STREET
Mailing Address - Street 2:NORTH SUBURBAN ORTHOPEDIC ASSOCIATES INC
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-321-8785
Mailing Address - Fax:781-321-8063
Practice Address - Street 1:602 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3743
Practice Address - Country:US
Practice Address - Phone:617-389-7211
Practice Address - Fax:617-389-7225
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000Y61011OtherBCBS GROUP
612930OtherTUFTS GROUP
Y68318OtherBCBS INDIV
613542OtherHARVARD PILGRIM GROUP
Y68318OtherBCBS INDIV
612930OtherTUFTS GROUP