Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 262968 | MA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 61907-21 | WI |
NPI | 1043536865 |
---|---|
Provider Name | Brett Joseph Teran |
First Address | Plymouth, MA 02360-4842 |
Second Address | Plymouth, MA 02360-4842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2010 |
Last Update Date | 29/05/2020 |