Provider Demographics
NPI:1538215785
Name:SIENKIEWICZ, TERESA (MS, PT)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:SIENKIEWICZ
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1014
Mailing Address - Country:US
Mailing Address - Phone:617-969-8995
Mailing Address - Fax:617-332-4314
Practice Address - Street 1:1155 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1014
Practice Address - Country:US
Practice Address - Phone:617-969-8995
Practice Address - Fax:617-332-4314
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67430OtherBLUE CROSS - BLUE SHIELD
MAY67430OtherBLUE CROSS - BLUE SHIELD