Provider Demographics
NPI:1710600093
Name:LOWELL PHYSICAL THERAPY 1
Entity Type:Organization
Organization Name:LOWELL PHYSICAL THERAPY 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTCO
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKESY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-455-4320
Mailing Address - Street 1:12 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3002
Mailing Address - Country:US
Mailing Address - Phone:617-461-8277
Mailing Address - Fax:
Practice Address - Street 1:325 CHELMSFORD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-4429
Practice Address - Country:US
Practice Address - Phone:978-455-4320
Practice Address - Fax:978-455-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy