Healthcare Provider Details

I. General information

NPI: 1801067426
Provider Name (Legal Business Name): ALPANA AJIT PEDNEKAR PT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2008
Last Update Date: 03/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GOVERNORS AVE
MEDFORD MA
02155-1644
US

IV. Provider business mailing address

36 DARTMOUTH ST APT 711
MALDEN MA
02148-5169
US

V. Phone/Fax

Practice location:
  • Phone: 781-391-5400
  • Fax:
Mailing address:
  • Phone: 857-891-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18148
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: