Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 9144 | MA |
NPI | 1033327960 |
---|---|
Provider Name | Ms. Kathleen Bridget Tracy |
First Address | Shrewsbury, MA 01545-4451 |
Second Address | Shrewsbury, MA 01545-3960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |