Provider Demographics
NPI:1932792173
Name:CEGLIO, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CEGLIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66B CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2179
Mailing Address - Country:US
Mailing Address - Phone:978-657-3826
Mailing Address - Fax:978-657-5705
Practice Address - Street 1:66B CONCORD ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2179
Practice Address - Country:US
Practice Address - Phone:978-657-3826
Practice Address - Fax:978-657-5705
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1343183225100000X
MA26590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist