Provider Demographics
NPI:1629618202
Name:CONWAY, MARY CASSIDY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CASSIDY
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:528 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1413
Mailing Address - Country:US
Mailing Address - Phone:978-501-0104
Mailing Address - Fax:
Practice Address - Street 1:126 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4991
Practice Address - Country:US
Practice Address - Phone:978-453-8331
Practice Address - Fax:978-455-3925
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA8782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist