Provider Demographics
NPI:1821441577
Name:DECHELLIS, EDWARD JR (PTA, MT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:DECHELLIS
Suffix:JR
Gender:M
Credentials:PTA, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 OLD WENDELL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01360-9674
Mailing Address - Country:US
Mailing Address - Phone:413-218-6715
Mailing Address - Fax:
Practice Address - Street 1:233 OLD WENDELL RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MA
Practice Address - Zip Code:01360-9674
Practice Address - Country:US
Practice Address - Phone:413-218-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3729225200000X
MA6291225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant