Individual
MRS. JENNIFER CONCANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DAT, LAT, ATC
Contact information
Practice address
65 WILSON AVE, WEYMOUTH, MA 02188-3623
(978) 273-3620
Mailing address
65 WILSON AVE, WEYMOUTH, MA 02188-3623
(978) 273-3620
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
2448
MA
2255A2300X
Athletic Trainer
Primary
2448
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2448
BOARD OF LICENSURE
MA
Enumeration date
01/18/2018
Last updated
12/27/2021
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