Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3044 | MA |
NPI | 1013213511 |
---|---|
Provider Name | Mr. Daniel Patrick Needham |
First Address | Rowley, MA 01969-1515 |
Second Address | Beverly, MA 01915-6198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2011 |
Last Update Date | 31/01/2011 |