Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10749 | MA |
NPI | 1003025867 |
---|---|
Provider Name | Mr. James Joseph Gaydos |
First Address | Lynn, MA 01904-3204 |
Second Address | Boston, MA 02120-2847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |