Provider Demographics
NPI:1598702813
Name:CABALTERA, THOMAS (BS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:CABALTERA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-4121
Mailing Address - Country:US
Mailing Address - Phone:978-452-6633
Mailing Address - Fax:978-935-2741
Practice Address - Street 1:278 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-4121
Practice Address - Country:US
Practice Address - Phone:978-452-6633
Practice Address - Fax:978-935-2741
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68853Medicare ID - Type Unspecified