Healthcare Provider Details

I. General information

NPI: 1255589818
Provider Name (Legal Business Name): DANA PAUL BOARDMAN KINESIOTHERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

28 OAKDALE ST
BROCKTON MA
02301-3317
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-2134
  • Fax: 774-826-2585
Mailing address:
  • Phone: 774-826-2134
  • Fax: 774-826-2585

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: