Healthcare Provider Details

I. General information

NPI: 1730016239
Provider Name (Legal Business Name): CARISSA CORCORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WOOD RD STE 108
BRAINTREE MA
02184-2000
US

IV. Provider business mailing address

73 NEWTON RD UNIT 101
PLAISTOW NH
03865-2440
US

V. Phone/Fax

Practice location:
  • Phone: 781-535-6053
  • Fax: 781-535-6056
Mailing address:
  • Phone: 978-388-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL89410
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: