Provider Demographics
NPI:1982724449
Name:SCANLON, WILLIAM F (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:SCANLON
Suffix:
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 1:722 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2516
Mailing Address - Country:US
Mailing Address - Phone:617-522-5550
Mailing Address - Fax:
Practice Address - Street 1:722 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2516
Practice Address - Country:US
Practice Address - Phone:617-522-5550
Practice Address - Fax:617-983-0884
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA7536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA37662OtherHARVARD PILGRIM
MA0006180OtherNEIGHBORHOOD HEALTH PLAN
MAY67013OtherBLUE CROSS
MA0301825Medicaid
MA0301825Medicaid