Healthcare Provider Details

I. General information

NPI: 1255047668
Provider Name (Legal Business Name): JACLYN MORGAN ARMSTRONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CHIPMAN WAY # 1039
KINGSTON MA
02364-1039
US

IV. Provider business mailing address

12 TAYLOR POINT RD
PEMBROKE MA
02359-2504
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-4100
  • Fax:
Mailing address:
  • Phone: 508-322-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA9710
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: