Provider Demographics
NPI:1194941054
Name:DRISCOLL, JOSEPH P (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TAYLOR POINT RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2503
Mailing Address - Country:US
Mailing Address - Phone:781-293-5514
Mailing Address - Fax:
Practice Address - Street 1:6 FORT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4959
Practice Address - Country:US
Practice Address - Phone:617-479-0200
Practice Address - Fax:617-471-2157
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9611225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant