Provider Demographics
NPI:1922098508
Name:HANLON, RAYMOND JOHN III (MS,PT/LATC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:JOHN
Last Name:HANLON
Suffix:III
Gender:M
Credentials:MS,PT/LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2425
Mailing Address - Country:US
Mailing Address - Phone:781-779-1581
Mailing Address - Fax:
Practice Address - Street 1:78 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2425
Practice Address - Country:US
Practice Address - Phone:781-779-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0399434Medicaid
MAY68972Medicare ID - Type Unspecified