Healthcare Provider Details

I. General information

NPI: 1942609672
Provider Name (Legal Business Name): CHRISTINE CHIARADONNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LINWOOD ST
LYNN MA
01905-1248
US

IV. Provider business mailing address

200 LINWOOD ST
LYNN MA
01905-1248
US

V. Phone/Fax

Practice location:
  • Phone: 781-913-4236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8706
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: