Individual
KENT P JASKOVIAK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
135 GOLD STAR BLVD, WORCESTER, MA 01606
(508) 856-9510
(508) 853-1907
Mailing address
630 PLANTATION ST, WOT 12TH FLOOR ATTN: PHYSICIAN SERVICES, WORCESTER, MA 01605
(508) 368-5529
(508) 368-5530
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13115
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0318922
MEDICAID WELFARE
—
05
—
0318922
—
MA
01
—
2779432
CIGNA HEALTH PLAN
—
01
—
2779432001
CIGNA PAL ID
—
01
—
35481155
CIGNA HEALTHSOURCE
—
01
—
43205
FALLON COMMUNITY HEALTH P
—
01
—
7248629
AETNA US HEALTHCARE
—
01
—
AA4052
HARVARD PILGRIM HEALTHCAR
—
01
—
Y67947
BLUE SHIELD HMO BLUE
—
01
—
Y68470
MEDICARE B
—
Enumeration date
01/09/2006
Last updated
07/08/2007
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