Provider Demographics
NPI:1164641528
Name:AGUILAR, EDWARD SHERWIN M (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD SHERWIN
Middle Name:M
Last Name:AGUILAR
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 1:510 MOUNT AUBURN ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4157
Mailing Address - Country:US
Mailing Address - Phone:617-923-2311
Mailing Address - Fax:
Practice Address - Street 1:510 MOUNT AUBURN ST
Practice Address - Street 2:APT. 5
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4157
Practice Address - Country:US
Practice Address - Phone:617-923-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist