Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 000025728 | MA |
NPI | 1083382873 |
---|---|
Provider Name | Ryan J Harty |
First Address | Medford, MA 02155-1179 |
Second Address | Beverly, MA 01915-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2021 |
Last Update Date | 06/09/2021 |