Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2262 | MA |
NPI | 1003097536 |
---|---|
Provider Name | Mrs. Diana Mary Kenney |
First Address | South Hadley, MA 01075-2630 |
Second Address | Springfield, MA 01109-3151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2007 |
Last Update Date | 27/11/2007 |