Provider Demographics
NPI:1568616126
Name:CREEDON, PAUL D (PT,MS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:CREEDON
Suffix:
Gender:M
Credentials:PT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319A SOUTHBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2598
Mailing Address - Country:US
Mailing Address - Phone:508-832-2628
Mailing Address - Fax:598-832-7824
Practice Address - Street 1:319A SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2598
Practice Address - Country:US
Practice Address - Phone:508-832-2628
Practice Address - Fax:508-832-7824
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic