Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 5476 | MA |
NPI | 1013015528 |
---|---|
Provider Name | John A. Kalogeris |
First Address | Lexington, MA 02420-4320 |
Second Address | Lexington, MA 02420-4320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |