Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 17297 | MA |
NPI | 1003210782 |
---|---|
Provider Name | Molly Chvatal |
First Address | Hyannis, MA 02601-3922 |
Second Address | Hyannis, MA 02601-3922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2014 |
Last Update Date | 09/10/2014 |