Healthcare Provider Details

I. General information

NPI: 1134735392
Provider Name (Legal Business Name): MEREDITH CELINE HARRINGTON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LIBERTY ST
BROCKTON MA
02301-5674
US

IV. Provider business mailing address

110 LIBERTY ST
BROCKTON MA
02301-5674
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7000
  • Fax:
Mailing address:
  • Phone: 978-340-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number3496
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: