Provider Demographics
NPI:1295574267
Name:SCHALEKAMP, ETHAN JAMES (DPT)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:JAMES
Last Name:SCHALEKAMP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ADAMS ST # 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2601
Mailing Address - Country:US
Mailing Address - Phone:518-396-7948
Mailing Address - Fax:
Practice Address - Street 1:376 BOYLSTON ST STE 201
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3828
Practice Address - Country:US
Practice Address - Phone:617-275-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist