Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1112 | MA |
NPI | 1023299922 |
---|---|
Provider Name | Mrs. Roxann E. Nickerson |
First Address | Andover, MA 01810-4302 |
Second Address | Andover, MA 01810-4302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2007 |
Last Update Date | 19/11/2007 |