| NPI | 1992125215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON PACHECO Billing/Credentialing 508-675-2840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 111N00000X Chiropractor |
| 174400000X Specialist | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2016-01-26 |