Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 4450 | MA |
NPI | 1205151040 |
---|---|
Provider Name | Mrs. Pamela Jean Pellegrini |
First Address | Kingston, MA 02364-1555 |
Second Address | Kingston, MA 02364-1555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2010 |
Last Update Date | 05/04/2010 |