Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 8696 | MA |
NPI | 1013110600 |
---|---|
Provider Name | Andrea B O'brien |
First Address | Watertown, MA 02472-1892 |
Second Address | Watertown, MA 02472-1892 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y67444 | BCBS OF MA (01) | MA |