Provider Demographics
NPI:1255809018
Name:TALKOWSKI, JAIME BERLIN (PHD MPT)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:BERLIN
Last Name:TALKOWSKI
Suffix:
Gender:F
Credentials:PHD MPT
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:ELIZABETH
Other - Last Name:BERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 WOODPARK CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7207
Mailing Address - Country:US
Mailing Address - Phone:857-202-0693
Mailing Address - Fax:
Practice Address - Street 1:35 BEDFORD ST STE 9
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4439
Practice Address - Country:US
Practice Address - Phone:781-863-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist