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NPI Code Detail

MEDICARE: ELENA HALSTROM DPT

MEDICARE: ELENA HALSTROM DPT
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
1225100000XPhysical Therapist19233MA

General Provider Information

NPI Number : 1366750622
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELENA HALSTROM DPT
Provider Business Mailing Address
First Line : 483 RIVER RD
Second Line :
City : CARLISLE
State : MA
Zip : 01741-1873
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 483 RIVER RD
Second Line :
City : CARLISLE
State : MA
Zip : 01741-1873
Country : US
Telephone Number : 978-369-0673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2010
Last Update Date : 09/30/2010

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Directions to “ ELENA HALSTROM DPT” Practice Location

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