Provider Demographics
NPI:1295733566
Name:EGAN, JEANNE CHRISTOPULOS (PT)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:CHRISTOPULOS
Last Name:EGAN
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:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-0604
Mailing Address - Country:US
Mailing Address - Phone:508-428-0300
Mailing Address - Fax:
Practice Address - Street 1:719 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1903
Practice Address - Country:US
Practice Address - Phone:508-428-0300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0375632Medicaid
MAY65135OtherBCBS OF MA
MAY65135Medicare ID - Type Unspecified