Healthcare Provider Details

I. General information

NPI: 1356476725
Provider Name (Legal Business Name): ANNE M FLAHERTY ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MICHAEL RD
BEVERLY MA
01915-1218
US

IV. Provider business mailing address

1 MICHAEL RD
BEVERLY MA
01915-1218
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-1638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number593
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: