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General NPI Number Information
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NPI Number | 1841460920
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Entity Type | Individual
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Provider Name | JERILYNN THISSE PT
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Gender | Female
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 519 MAIN ST
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City | MEDFIELD
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State | MA
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Zip | 02052-2522
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Country | US
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Telephone | 508-359-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 80 ACCESS RD
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City | NORWOOD
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State | MA
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Zip | 02062-5237
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Country | US
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Telephone |
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 6739
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License Number State | MA
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