Provider Demographics
NPI:1104467646
Name:NYE, THOMAS EDWARD
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:NYE
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 1:22 NAPLES AVE
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1350
Mailing Address - Country:US
Mailing Address - Phone:781-502-1439
Mailing Address - Fax:
Practice Address - Street 1:22 NAPLES AVE
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1350
Practice Address - Country:US
Practice Address - Phone:781-502-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer