Healthcare Provider Details

I. General information

NPI: 1679517262
Provider Name (Legal Business Name): EILEEN MARIE CRAFFEY RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY REHAB. MEDICINE SERVICE
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

229 MILLER ST
MIDDLEBORO MA
02346-3137
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-7700
  • Fax:
Mailing address:
  • Phone: 617-323-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: