Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 19765 | MA |
NPI | 1053923805 |
---|---|
Provider Name | Kristen Bastide |
First Address | Ashland, MA 01721-2514 |
Second Address | Natick, MA 01760-1770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2020 |
Last Update Date | 21/08/2020 |