Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 6929 | MA |
NPI | 1053319848 |
---|---|
Provider Name | Dr. Stacey L Raybuck |
First Address | Hopkinton, MA 01748-1299 |
Second Address | Franklin, MA 02038-2912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 30/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0358746 | (05) | MA |