Provider Demographics
NPI:1710977665
Name:VISNICK, ALAN LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:LEE
Last Name:VISNICK
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 1:101 CAMBRIDGE ST
Mailing Address - Street 2:ORTHOPAEDICS PLUS SUITE 230
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3766
Mailing Address - Country:US
Mailing Address - Phone:781-229-8011
Mailing Address - Fax:781-229-8374
Practice Address - Street 1:101 CAMBRIDGE ST
Practice Address - Street 2:ORTHOPAEDICS PLUS SUITE 230
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3766
Practice Address - Country:US
Practice Address - Phone:781-229-8011
Practice Address - Fax:781-229-8374
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0345865Medicaid
MA0345865Medicaid