Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1891803466 |
---|---|
Provider Name | Mr. Michael Ray Dewey |
First Address | Norton, MA 02766-3439 |
Second Address | Brockton, MA 02301-5596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |