Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 1192 | NH |
Y | 225200000X | Physical Therapy Assistant | 9139 | MA |
NPI | 1003274119 |
---|---|
Provider Name | Mrs. Megan Annino |
First Address | Andover, MA 01810-1437 |
Second Address | Andover, MA 01810-1437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 03/02/2016 |