Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 18764 | MA |
NPI | 1003149774 |
---|---|
Provider Name | Katherine Shao |
First Address | Bedford, MA 01730-1553 |
Second Address | Brockton, MA 02301-7501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2009 |
Last Update Date | 14/10/2014 |