Provider Demographics
NPI:1104316678
Name:KRISTIN LOHAN PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:KRISTIN LOHAN PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ROWE
Authorized Official - Last Name:LOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT
Authorized Official - Phone:781-929-5241
Mailing Address - Street 1:213 ESSEX ST # 1
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1150
Mailing Address - Country:US
Mailing Address - Phone:781-929-5241
Mailing Address - Fax:781-469-0617
Practice Address - Street 1:213 ESSEX ST # 1
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907
Practice Address - Country:US
Practice Address - Phone:978-341-4238
Practice Address - Fax:781-469-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10805261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1518941897Medicaid