Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 17280 | MA |
N | 213ES0000X | Sports Medicine | 17280 | MA |
Y | 225100000X | Physical Therapist | 17280 | MA |
NPI | 1366034076 |
---|---|
Provider Name | Kristin Panora Egan |
First Address | Norwell, MA 02061 |
Second Address | Norwell, MA 02061-1683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2021 |
Last Update Date | 04/02/2021 |