Provider Demographics
NPI:1699075747
Name:MEISNER, JEFFREY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:MEISNER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:188 PROVIDENCE STREET
Mailing Address - Street 2:BOSTON PAIN CLINIC
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136
Mailing Address - Country:US
Mailing Address - Phone:617-361-2166
Mailing Address - Fax:617-364-3871
Practice Address - Street 1:188 PROVIDENCE STREET
Practice Address - Street 2:BOSTON PAIN CLINIC
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136
Practice Address - Country:US
Practice Address - Phone:617-361-2166
Practice Address - Fax:617-364-3871
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4900OtherSTATE LICENSE