Healthcare Provider Details

I. General information

NPI: 1194968222
Provider Name (Legal Business Name): EILEEN MAZZULLI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LINDEN PONDS OUTPATIENT REHABILITATION CLINIC 205 LINDEN PONDS WAY
HINGHAM MA
02043
US

IV. Provider business mailing address

LINDEN PONDS OUTPATIENT REHABILITATION CLINIC 205 LINDEN PONDS WAY
HINGHAM MA
02043
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-7160
  • Fax: 781-534-7382
Mailing address:
  • Phone: 781-534-7160
  • Fax: 781-534-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6017
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: