Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 15505 | MA |
NPI | 1083696579 |
---|---|
Provider Name | Dr. Michael Joseph Stare |
First Address | Windham, NH 03087-2388 |
Second Address | Beverly, MA 01915-6115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 26/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0316326 | (05) | MA |