NPI

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NPI 1275206047

Read from the NPPES registry on October 23, 2026.

Facts

Status
Active
Credential
PT
Type
Individual
Enumeration date
2021-07-28
Last updated
2021-07-28

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Specialties

Licenses

License MA
25558

Location

Practice location
730 Main St Ste 2d
City
Millis MA
Postal code
02054-1612
Phone
(508) 376-0881

Medicare

PECOS
A PECOS enrollment row matches this NPI.

LEIE

No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. Confirm on OIG's online search.

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Nearby

Other NPIs in Millis, MA. 116 records in the public file.

Public data from NPPES and CMS. Not a credentialing determination.

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