Provider Demographics
NPI:1346204468
Name:O'SULLIVAN, JOHN J (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1466
Mailing Address - Country:US
Mailing Address - Phone:413-586-8400
Mailing Address - Fax:866-644-0872
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1466
Practice Address - Country:US
Practice Address - Phone:413-586-8400
Practice Address - Fax:866-644-0872
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2329164OtherAETNA/US HEALTHCARE
MA0332071Medicaid
MA63862OtherFALLON COMMUNITY HEALTH PLAN
MA712451OtherCONNECTICARE
MAY67777OtherBLUE CROSS BLUE SHIELD
MA470226OtherTUFTS HEALTH PLAN
MA650020139OtherRAILROAD MEDICARE
MA626166OtherHARVARD PILGRIM HEALTH CA
MA24189OtherHEALTH NEW ENGLAND
MATX1347Medicare PIN
MAY67777OtherBLUE CROSS BLUE SHIELD