Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 22854 | MA |
NPI | 1013517911 |
---|---|
Provider Name | Madeleine Bonneville |
First Address | Newton, MA 02460-2037 |
Second Address | Roslindale, MA 02131-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2020 |
Last Update Date | 29/10/2020 |