Provider Demographics
NPI:1699749325
Name:JEAN, ROBERT D (ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:JEAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1810
Mailing Address - Country:US
Mailing Address - Phone:978-532-7767
Mailing Address - Fax:
Practice Address - Street 1:84 HIGHLAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2727
Practice Address - Country:US
Practice Address - Phone:978-741-0880
Practice Address - Fax:978-740-5595
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2131225200000X
MA5972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer