Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2711 | MA |
NPI | 1003031964 |
---|---|
Provider Name | Ms. Angela Roy |
First Address | Worcester, MA 01605-1715 |
Second Address | Worcester, MA 01605-1715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |