Provider Demographics
NPI:1013039494
Name:FAY, NELL L (DPT)
Entity Type:Individual
Prefix:MS
First Name:NELL
Middle Name:L
Last Name:FAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RESEARCH PL
Mailing Address - Street 2:STE 220
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2455
Mailing Address - Country:US
Mailing Address - Phone:781-321-8785
Mailing Address - Fax:781-321-8063
Practice Address - Street 1:405 PEARL ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6644
Practice Address - Country:US
Practice Address - Phone:781-321-8785
Practice Address - Fax:781-321-8063
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000Y61011OtherBCBS GROUP NUMBER
MA612930OtherTUFTS
MA613542OtherHARVARD PILGRIM