Basic Information
| Provider Information | |||||||||
| NPI: | 1346204468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'SULLIVAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8019 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011028000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664314077 | ||||||||
| FaxNumber: | 4137747448 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 MAIN ST | ||||||||
| Address2: | NORTHAMPTON HEALTH CENTER | ||||||||
| City: | FLORENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010621466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135868400 | ||||||||
| FaxNumber: | 4135869286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8731 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 24189 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 626166 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | 0332071 | 05 | MA | MEDICAID | 2329164 | 01 | MA | AETNA/US HEALTHCARE | OTHER | 470226 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 63862 | 01 | MA | FALLON COMMUNITY HEALTH PLAN | OTHER | 650020139 | 01 | MA | RAILROAD MEDICARE | OTHER | 712451 | 01 | MA | CONNECTICARE | OTHER | Y67777 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |