Provider Demographics
NPI:1801894381
Name:MACINTYRE, NEIL BLUE JR (PT)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:BLUE
Last Name:MACINTYRE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2640
Mailing Address - Country:US
Mailing Address - Phone:508-853-4590
Mailing Address - Fax:949-756-4811
Practice Address - Street 1:280 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2640
Practice Address - Country:US
Practice Address - Phone:508-753-7780
Practice Address - Fax:508-753-7719
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016294-1225100000X
MA20807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0597Medicare PIN