Provider Demographics
NPI:1932505948
Name:DELEO, MAEGEN BRADY (DPT)
Entity Type:Individual
Prefix:DR
First Name:MAEGEN
Middle Name:BRADY
Last Name:DELEO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:71 WICKLOW AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2825
Mailing Address - Country:US
Mailing Address - Phone:860-899-9652
Mailing Address - Fax:
Practice Address - Street 1:6 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2913
Practice Address - Country:US
Practice Address - Phone:617-846-0832
Practice Address - Fax:617-846-2594
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic