Provider Demographics
NPI:1407884166
Name:NEKERVIS, J. STEPHEN JR (LATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:J. STEPHEN
Middle Name:
Last Name:NEKERVIS
Suffix:JR
Gender:M
Credentials:LATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DAVIS RD APT C5
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4729
Mailing Address - Country:US
Mailing Address - Phone:978-877-0572
Mailing Address - Fax:
Practice Address - Street 1:19 DAVIS RD APT C5
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4729
Practice Address - Country:US
Practice Address - Phone:978-877-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAHA9842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer