Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 9971 | MA |
NPI | 1013675149 |
---|---|
Provider Name | Kaylee Beauregard |
First Address | Pittsfield, MA 01201-1316 |
Second Address | Great Barrington, MA 01230-1199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2021 |
Last Update Date | 06/12/2021 |