Provider Demographics
NPI:1205180635
Name:LORDAN, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:LORDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 MAIN ST
Mailing Address - Street 2:STE G
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1755
Mailing Address - Country:US
Mailing Address - Phone:508-668-8900
Mailing Address - Fax:508-668-8901
Practice Address - Street 1:1333 MAIN ST
Practice Address - Street 2:STE G
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1755
Practice Address - Country:US
Practice Address - Phone:508-668-8900
Practice Address - Fax:508-668-8901
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist