Provider Demographics
NPI:1184751679
Name:SVANES, MARGIT PORSHOLT (PT)
Entity type:Individual
Prefix:
First Name:MARGIT
Middle Name:PORSHOLT
Last Name:SVANES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MUZZEY ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5256
Mailing Address - Country:US
Mailing Address - Phone:781-862-7460
Mailing Address - Fax:781-862-4420
Practice Address - Street 1:19 MUZZEY ST
Practice Address - Street 2:SUITE 309
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5256
Practice Address - Country:US
Practice Address - Phone:781-862-7460
Practice Address - Fax:781-862-4420
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA608626OtherHARVARD PILGRIM
MA0000Y65154OtherBLUE CROSS BLUE SHIELD
MA707126OtherTUFTS
MA0348112Medicaid
MAY65154Medicare PIN