Healthcare Provider Details

I. General information

NPI: 1720544364
Provider Name (Legal Business Name): BRIDGET LOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6204 INWOOD DR
WOBURN MA
01801-5152
US

IV. Provider business mailing address

6204 INWOOD DR
WOBURN MA
01801-5152
US

V. Phone/Fax

Practice location:
  • Phone: 508-713-5835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberS44443453
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: