Provider Demographics
NPI:1205837036
Name:INACIO, JOHN WAYNE (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WAYNE
Last Name:INACIO
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1245
Mailing Address - Country:US
Mailing Address - Phone:508-647-2299
Mailing Address - Fax:
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1131
Practice Address - Country:US
Practice Address - Phone:508-650-1856
Practice Address - Fax:508-653-9563
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65359OtherMASSACHUSETTS BLUE CROSS BLUE SHIELD
MA469186OtherTUFTS
MA0370797Medicaid
MAY65359OtherMASSACHUSETTS BLUE CROSS BLUE SHIELD