Provider Demographics
NPI:1174590616
Name:MORRISSEY, JOAN MARIE
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 COOLIDGE ST
Mailing Address - Street 2:STE 222
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1331
Mailing Address - Country:US
Mailing Address - Phone:978-562-0345
Mailing Address - Fax:
Practice Address - Street 1:131 COOLIDGE ST
Practice Address - Street 2:STE 222
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1331
Practice Address - Country:US
Practice Address - Phone:978-562-0345
Practice Address - Fax:978-562-0257
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67982OtherBLUE CROSS BLUE SHIELD
MA0395501Medicaid
MA2882540OtherAETNA
MA469167/MORRISSEOtherTUFTS HEALTH PLAN
MAY68787Medicare ID - Type Unspecified