Individual
MARK POWICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
63 S MAIN ST, RANDOLPH, MA 02368-4862
(781) 961-4460
Mailing address
63 S MAIN ST, RANDOLPH, MA 02368-4862
(781) 961-4460
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11449
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110020320A
—
MA
Enumeration date
10/24/2005
Last updated
12/06/2022
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