Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 10767-AH-PT | MA |
NPI | 1134634082 |
---|---|
Provider Name | Victoria Kilroy |
First Address | Amesbury, MA 01913-2139 |
Second Address | Amesbury, MA 01913-2139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2017 |
Last Update Date | 13/12/2017 |