Provider Demographics
NPI:1629279765
Name:LUSCINSKI, JEANNIE (PTA)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:LUSCINSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HARBORVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-2290
Mailing Address - Country:US
Mailing Address - Phone:781-267-1497
Mailing Address - Fax:
Practice Address - Street 1:14 HARBORVIEW DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-2290
Practice Address - Country:US
Practice Address - Phone:781-267-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2583225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant