| NPI | 1649410507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VYACHESLAV DENISHENKO Resident Agent 617-424-4749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 11124) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2009-03-04 |