Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | MA |
NPI | 1336362094 |
---|---|
Provider Name | Angela Plummer |
First Address | Medford, MA 02155-5027 |
Second Address | Medford, MA 02155-1644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |