Provider Demographics
NPI:1700865672
Name:LEWCZYK, JOHN J (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:LEWCZYK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL ST2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-856-9510
Mailing Address - Fax:508-853-1907
Practice Address - Street 1:112 HARDING ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-5020
Practice Address - Country:US
Practice Address - Phone:508-964-5592
Practice Address - Fax:508-453-8185
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y67941OtherBLUE CARE ELECT
2779432OtherCIGNA HEALTH PLAN
650017412OtherRAILROAD MEDICARE
Y67941OtherBLUE SHIELD HMO BLUE
Y68466OtherMEDICARE B
042472266OtherONE HEALTH PLAN
2779432001OtherCIGNA PAL ID
56640OtherCHILDRENS MEDICAL SECURIT
35481155OtherCIGNA HEALTHSOURCE
785957OtherMVP HEALTH CARE
43207OtherFALLON COMMUNITY HEALTH
0318949OtherMEDICAID WELFARE
MA0318949Medicaid
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherPRIVATE HEALTHCARE SYSTEM
7199625OtherAETNA US HEALTHCARE
AA4052OtherHARVARD PILGRIM HEALTHCAR
042472266OtherTHREE RIVERS
Y67941OtherBLUE SHIELD INDEMNITY
MAY68466Medicare ID - Type Unspecified