Provider Demographics
NPI:1144656166
Name:PEZICK, JUSTIN MARSHALL (PT, DPT, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:MARSHALL
Last Name:PEZICK
Suffix:
Gender:M
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MIDDLESEX TPKE STE 101L
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1417
Mailing Address - Country:US
Mailing Address - Phone:781-229-8011
Mailing Address - Fax:781-229-8374
Practice Address - Street 1:54 MIDDLESEX TPKE STE 101L
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730
Practice Address - Country:US
Practice Address - Phone:781-229-8011
Practice Address - Fax:781-229-8374
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20748261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy