Healthcare Provider Details

I. General information

NPI: 1427513506
Provider Name (Legal Business Name): KIMBERLY JANE O'SULLIVAN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306A HIGH ST
GREENFIELD MA
01301-2611
US

IV. Provider business mailing address

306A HIGH ST
GREENFIELD MA
01301-2611
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-3379
  • Fax: 413-776-5050
Mailing address:
  • Phone: 413-773-3379
  • Fax: 413-776-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15196
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: