Healthcare Provider Details

I. General information

NPI: 1306869151
Provider Name (Legal Business Name): DIONNE DELORIE ESPEUT-MITCHELL RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S. HUNTINGTON AVE 117- PM&RS
BOSTON MA
02130
US

IV. Provider business mailing address

BOSTON HEALTHCARE SYSTEM ,150 S. HUNTINGTON AVE 117- PM&RS
BOSTON MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax: 857-364-4513
Mailing address:
  • Phone: 617-232-9500
  • Fax: 857-364-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: