Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2777 | MA |
NPI | 1023115284 |
---|---|
Provider Name | Michael A. Terwilliger |
First Address | Greenfield, MA 01301-2507 |
Second Address | Greenfield, MA 01301-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |