Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 438845 | MA |
NPI | 1003270315 |
---|---|
Provider Name | Selina Fay |
First Address | Woburn, MA 01801-7452 |
Second Address | Woburn, MA 01801-7452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2016 |
Last Update Date | 12/04/2016 |