Provider Demographics
NPI:1356184212
Name:VAZQUEZ, JOHN A SR (MED, CLT, LMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:VAZQUEZ
Suffix:SR
Gender:M
Credentials:MED, CLT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 STARBOARD LN
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1432
Mailing Address - Country:US
Mailing Address - Phone:413-210-8529
Mailing Address - Fax:
Practice Address - Street 1:677 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3493
Practice Address - Country:US
Practice Address - Phone:413-210-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225700000X
171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty