Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 7424 | MA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 7424 | MA |
NPI | 1033171459 |
---|---|
Provider Name | Ms. Deborah Denise Maia |
First Address | Sheffield, MA 01257-1277 |
Second Address | Sheffield, MA 01257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 17/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y66894 | BLUE CROSS/BLUE SHIELD (01) | MD |