Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 8810 | MA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 8810 | MA |
NPI | 1285723049 |
---|---|
Provider Name | Richard Qualter |
First Address | Sagamore Beach, MA 02562-2538 |
Second Address | East Harwich, MA 02645-1316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 23/04/2020 |