Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 19709 | MA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT011526 | GA |
NPI | 1093123358 |
---|---|
Provider Name | Marie Carreras |
First Address | Randolph, MA 02368-4633 |
Second Address | Stoughton, MA 02072-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2014 |
Last Update Date | 06/02/2018 |