Healthcare Provider Details

I. General information

NPI: 1124497136
Provider Name (Legal Business Name): KIMBERLY LYNN LAPRADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2015
Last Update Date: 09/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N MAIN ST
SOUTH YARMOUTH MA
02664-2083
US

IV. Provider business mailing address

15 DIMASSA DR
LEOMINSTER MA
01453-2121
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-3514
  • Fax:
Mailing address:
  • Phone: 978-833-7578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8990
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: