Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1023020559 |
---|---|
Provider Name | Mr. Edward Francis Mccormack |
First Address | South Weymouth, MA 02190-2141 |
Second Address | Brockton, MA 02301-5596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 08/07/2007 |