Provider Demographics
NPI:1023137577
Name:LEMBO, MARK (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:LEMBO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:300 OAK ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1984
Mailing Address - Country:US
Mailing Address - Phone:781-829-9966
Mailing Address - Fax:781-829-2164
Practice Address - Street 1:300 OAK ST
Practice Address - Street 2:SUITE 450
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1984
Practice Address - Country:US
Practice Address - Phone:781-829-9966
Practice Address - Fax:781-829-2164
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67514OtherBLUE CROSS BLUE SHIELD
MA468731OtherTUFTS
MA0030198OtherNEIGHBORHOOD HEALTH PLAN
MA3279637OtherAETNA
MA468731OtherTUFTS