Healthcare Provider Details

I. General information

NPI: 1598791402
Provider Name (Legal Business Name): KEVIN FLAHERTY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LINWOOD AVE SUITE 2
WHITINSVILLE MA
01588-2068
US

IV. Provider business mailing address

670 LINWOOD AVE SUITE 2
WHITINSVILLE MA
01588-2068
US

V. Phone/Fax

Practice location:
  • Phone: 508-234-7544
  • Fax: 508-234-8002
Mailing address:
  • Phone: 508-234-7544
  • Fax: 508-234-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8633
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: