Provider Demographics
NPI:1962151670
Name:QUEVILLON, JOHN ALLEN (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:QUEVILLON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 TOWN FARM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01506-1744
Mailing Address - Country:US
Mailing Address - Phone:508-397-0606
Mailing Address - Fax:
Practice Address - Street 1:133 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2691
Practice Address - Country:US
Practice Address - Phone:774-449-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist