Provider Demographics
NPI:1750444055
Name:KALOGERIS PHYSICAL THERAPY CENTER PC
Entity Type:Organization
Organization Name:KALOGERIS PHYSICAL THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALOGERIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-863-1801
Mailing Address - Street 1:35 BEDFORD ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4320
Mailing Address - Country:US
Mailing Address - Phone:781-863-1801
Mailing Address - Fax:781-274-6005
Practice Address - Street 1:35 BEDFORD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-863-1801
Practice Address - Fax:781-274-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0007Medicare PIN
MAVX3395Medicare PIN