Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 23989 | MA |
NPI | 1134881634 |
---|---|
Provider Name | Mrs. Rebecca L Coutts |
First Address | Newton, MA 02461-1909 |
Second Address | Boston, MA 02116-2848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2021 |
Last Update Date | 12/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1891190229 | TB12 NPI (01) | MA |