Healthcare Provider Details

I. General information

NPI: 1376562504
Provider Name (Legal Business Name): CHRISTINE AMARAL DETORE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N MAIN ST C O ACTIVE PHYSICAL THERAPY
BELLINGHAM MA
02019
US

IV. Provider business mailing address

40 N MAIN ST C O ACTIVE PHYSICAL THERAPY
BELLINGHAM MA
02019
US

V. Phone/Fax

Practice location:
  • Phone: 508-966-2717
  • Fax: 508-966-2095
Mailing address:
  • Phone: 508-966-2717
  • Fax: 508-966-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16936
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: