MEDICARE: IAN KARBY PT, DPT, ATC

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	25373	MA

General Provider Information

NPI Number	:	1043896426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN KARBY PT, DPT, ATC

Provider Business Mailing Address
First Line	:	32 PROSPECT ST APT 3
Second Line	:
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-3468
Country	:	US
Telephone Number	:	207-317-0595
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 MELCHER ST STE 100
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02210-1534
Country	:	US
Telephone Number	:	617-536-1161
Fax Number	:

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

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/24/2021

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