Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 10821 | MA |
Y | 2251S0007X | Physical Therapist - Sports | 10821 | MA |
NPI | 1497965719 |
---|---|
Provider Name | Heather Southwick |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 19/11/2020 |