Healthcare Provider Details

I. General information

NPI: 1972890432
Provider Name (Legal Business Name): CINDY LEE FAGGIONI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHERRY ST
HOLYOKE MA
01040-7002
US

IV. Provider business mailing address

110 CHERRY ST
HOLYOKE MA
01040-7002
US

V. Phone/Fax

Practice location:
  • Phone: 413-539-6910
  • Fax: 413-539-6840
Mailing address:
  • Phone: 413-539-6910
  • Fax: 413-539-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16687
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: