Provider Demographics
NPI:1518367465
Name:FREDERICK, JAMES (DPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WILLARD ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1200
Mailing Address - Country:US
Mailing Address - Phone:617-471-5053
Mailing Address - Fax:617-984-0636
Practice Address - Street 1:540 GALLIVAN BLVD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5400
Practice Address - Country:US
Practice Address - Phone:617-282-1200
Practice Address - Fax:617-282-9988
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist