Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 19300 | MA |
NPI | 1003189234 |
---|---|
Provider Name | Kelley Morgan |
First Address | Greene, RI 02827-1613 |
Second Address | Boston, MA 02111-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2012 |
Last Update Date | 22/05/2012 |