Healthcare Provider Details

I. General information

NPI: 1033100656
Provider Name (Legal Business Name): JODI A LLACERA KLEIN MS DPT OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BEACH ST SUITE 101
MANCHESTER MA
01944-1468
US

IV. Provider business mailing address

40 BEACH ST SUITE 101
MANCHESTER MA
01944-1468
US

V. Phone/Fax

Practice location:
  • Phone: 978-526-8288
  • Fax: 978-526-7084
Mailing address:
  • Phone: 978-526-8288
  • Fax: 978-526-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6128
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: