MEDICARE: MISS JUDITH DALE HERSHBERG PT, DPT, MS

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	1619	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	603413	OTHER	MA	HARVARD PILGRIM
2	8211	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
3	0009276	OTHER	MA	AETNA
4	10230200	OTHER	MA	ACS
5	467779	OTHER	MA	TUFTS HEALTH PLAN
6	Y66014	OTHER	MA	BLUE CROSS
7	6440025	OTHER	MA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1801834635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JUDITH DALE HERSHBERG PT, DPT, MS

Provider Business Mailing Address
First Line	:	241 PERKINS ST
Second Line	:	B702
City	:	BOSTON
State	:	MA
Zip	:	02130-4002
Country	:	US
Telephone Number	:	617-566-9342
Fax Number	:	617-566-3944

Provider Business Practice Location Address
First Line	:	653 SUMMER ST
Second Line	:	2ND FLOOR
City	:	BOSTON
State	:	MA
Zip	:	02210-2108
Country	:	US
Telephone Number	:	617-269-6262
Fax Number	:	617-269-1068

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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Directions to “ MISS JUDITH DALE HERSHBERG PT, DPT, MS” Practice Location

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