Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 24669 | MA |
NPI | 1043856602 |
---|---|
Provider Name | Steven Joseph Mccormack |
First Address | Danvers, MA 01923-3564 |
Second Address | Danvers, MA 01923-3564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 19/11/2019 |