Healthcare Provider Details

I. General information

NPI: 1174135172
Provider Name (Legal Business Name): HAILEY A FACENDOLA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 MIDDLESEX ST
LOWELL MA
01851-1130
US

IV. Provider business mailing address

71 PORTER TER
LOWELL MA
01852-2724
US

V. Phone/Fax

Practice location:
  • Phone: 978-710-7204
  • Fax:
Mailing address:
  • Phone: 781-258-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: