Healthcare Provider Details

I. General information

NPI: 1619370665
Provider Name (Legal Business Name): JENNIFER MCBRIDE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MECHANIC ST
FOXBORO MA
02035-2012
US

IV. Provider business mailing address

1 CREDIT UNION WAY FL 3
RANDOLPH MA
02368-4633
US

V. Phone/Fax

Practice location:
  • Phone: 508-203-9350
  • Fax: 508-203-9355
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-961-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: