| NPI | 1679904718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMON M CORNELISSEN Member/Provider 781-344-3535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2014-05-29 |