Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 60050 | OR |
Y | 2251S0007X | Physical Therapist - Sports | 19912 | MA |
NPI | 1356687677 |
---|---|
Provider Name | Kristina S Fleming |
First Address | Boston, MA 02114-2743 |
Second Address | Boston, MA 02114-2743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2012 |
Last Update Date | 19/05/2015 |