Healthcare Provider Details

I. General information

NPI: 1437275583
Provider Name (Legal Business Name): PATRICIA ANNE CHASTAIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST WANG ACC ROOM 134
BOSTON MA
02114-3117
US

IV. Provider business mailing address

122 W CONCORD ST # 1
BOSTON MA
02118-1508
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-1663
  • Fax:
Mailing address:
  • Phone: 617-247-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number3154
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: