Provider Demographics
NPI:1013015528
Name:KALOGERIS, JOHN A (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KALOGERIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEDFORD ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4320
Mailing Address - Country:US
Mailing Address - Phone:781-863-1801
Mailing Address - Fax:781-274-6005
Practice Address - Street 1:35 BEDFORD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-863-1801
Practice Address - Fax:781-274-6005
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65227Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER
MAPT0007Medicare ID - Type UnspecifiedGROUP PRACTICE