Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 25756 | MA |
NPI | 1023786019 |
---|---|
Provider Name | Jason Tan |
First Address | Quincy, MA 02170-1229 |
Second Address | Quincy, MA 02169-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 02/09/2021 |