Healthcare Provider Details

I. General information

NPI: 1134425911
Provider Name (Legal Business Name): JANNELLE MARIE FLYNN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BROAD ST
WEYMOUTH MA
02188-2336
US

IV. Provider business mailing address

125 BROAD ST
WEYMOUTH MA
02188-2336
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-3121
  • Fax: 781-337-3802
Mailing address:
  • Phone: 781-337-3121
  • Fax: 781-337-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number8480
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: