Provider Demographics
NPI:1427516004
Name:GEORGE, JOMY JEESON (PT)
Entity type:Individual
Prefix:
First Name:JOMY
Middle Name:JEESON
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:FNJ
Other - Middle Name:M
Other - Last Name:JOMY THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1215
Mailing Address - Country:US
Mailing Address - Phone:508-460-3291
Mailing Address - Fax:508-481-3706
Practice Address - Street 1:24 NEWTON ST
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1215
Practice Address - Country:US
Practice Address - Phone:508-460-3291
Practice Address - Fax:508-481-3706
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist