MEDICARE: MRS. ANDREA LYNN PATRUNO MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	15975	MA

General Provider Information

NPI Number	:	1033316245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA LYNN PATRUNO MPT

Provider Business Mailing Address
First Line	:	PO BOX 164
Second Line	:
City	:	BLANDFORD
State	:	MA
Zip	:	01008-0164
Country	:	US
Telephone Number	:	413-768-8559
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAINT VINCENTS HOSPITAL AT WORCESTER MEDICAL CENTER
Second Line	:	123 SUMMER STREET
City	:	WORCESTER
State	:	MA
Zip	:	01608
Country	:	US
Telephone Number	:	508-363-6205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	10/26/2014

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