Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 9190 | MA |
NPI | 1255322368 |
---|---|
Provider Name | Jill E Lewin |
First Address | Springfield, MA 01107-1111 |
Second Address | Springfield, MA 01107-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y67086 | BLUE SHIELD (01) | MA |