Provider Demographics
NPI:1821343971
Name:PEKOR, JONATHAN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PEKOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2669
Mailing Address - Country:US
Mailing Address - Phone:508-251-1819
Mailing Address - Fax:508-251-1879
Practice Address - Street 1:262 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2669
Practice Address - Country:US
Practice Address - Phone:508-251-1819
Practice Address - Fax:508-251-1879
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035186225100000X
MA20801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist