Provider Demographics
NPI:1760150635
Name:BOMBACI, CONNOR JOHN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:JOHN
Last Name:BOMBACI
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5209
Mailing Address - Country:US
Mailing Address - Phone:978-595-4120
Mailing Address - Fax:
Practice Address - Street 1:4 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-2020
Practice Address - Country:US
Practice Address - Phone:978-219-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist