Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 23567 | MA |
N | 225100000X | Physical Therapist | 40QA01616900 | NJ |
N | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1033604251 |
---|---|
Provider Name | Damara Viray |
First Address | Brighton, MA 02135-3602 |
Second Address | Brighton, MA 02135-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2018 |
Last Update Date | 06/04/2020 |