Provider Demographics
NPI:1780735191
Name:MUSHNICK, NANCY ELIZABETH (RPT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
Last Name:MUSHNICK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ELIZABETH
Other - Last Name:BLOOMFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:9 WASHBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2225
Mailing Address - Country:US
Mailing Address - Phone:978-443-8386
Mailing Address - Fax:978-443-8386
Practice Address - Street 1:9 WASHBROOK RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2225
Practice Address - Country:US
Practice Address - Phone:978-443-8386
Practice Address - Fax:978-443-8386
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMUY68934Medicare ID - Type UnspecifiedPHYSICAL THERAPY