Provider Demographics
NPI:1982858668
Name:MCEWEN, JESSICA MAE (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAE
Last Name:MCEWEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTENNIAL DR
Mailing Address - Street 2:EAST ENTRANCE
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7900
Mailing Address - Country:US
Mailing Address - Phone:978-826-7230
Mailing Address - Fax:978-826-7230
Practice Address - Street 1:10 CENTENNIAL DR
Practice Address - Street 2:EAST ENTRANCE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7900
Practice Address - Country:US
Practice Address - Phone:978-826-7230
Practice Address - Fax:978-826-7230
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA488338172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist