Healthcare Provider Details

I. General information

NPI: 1841780210
Provider Name (Legal Business Name): KBEDONI PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SEABURY ST
WEYMOUTH MA
02191-2042
US

IV. Provider business mailing address

70 SEABURY ST
WEYMOUTH MA
02191-2042
US

V. Phone/Fax

Practice location:
  • Phone: 781-864-9719
  • Fax:
Mailing address:
  • Phone: 781-864-9719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number13001
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLIE BEDONI
Title or Position: OWNER
Credential: DPT
Phone: 781-864-9719