Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1255589818 |
---|---|
Provider Name | Mr. Dana Paul Boardman |
First Address | Brockton, MA 02301-3317 |
Second Address | Brockton, MA 02301-5596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 08/09/2008 |