Provider Demographics
NPI:1619031127
Name:PASSARETTI, NICHOLAS (PT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:PASSARETTI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1800
Mailing Address - Country:US
Mailing Address - Phone:508-533-5778
Mailing Address - Fax:508-533-5778
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1800
Practice Address - Country:US
Practice Address - Phone:508-533-5778
Practice Address - Fax:508-533-5778
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65842Medicare ID - Type Unspecified