Healthcare Provider Details

I. General information

NPI: 1548248669
Provider Name (Legal Business Name): ASRA M USMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 COMMONWEALTH AVE
BOSTON MA
02215
US

IV. Provider business mailing address

915 COMMONWEALTH AVE
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-358-3700
  • Fax: 617-358-3710
Mailing address:
  • Phone: 617-358-3700
  • Fax: 617-358-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15861
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: