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General NPI Number Information
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NPI Number | 1619791027
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Entity Type | Individual
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Provider Name | JENNIFER KELLY PLOURDE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 51 PERFORMANCE DR
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City | WEYMOUTH
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State | MA
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Zip | 02189-3141
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Country | US
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Telephone | 781-682-0530
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Fax |
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Provider Business Mailing Address
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Address Line | 1686 WASHINGTON ST
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City | CANTON
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State | MA
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Zip | 02021-1640
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Country | US
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Telephone | 781-571-1051
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 18458
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License Number State | MA
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