=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891816005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC GETKIN P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 03/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4593 WASHINGTON ST
-----------------------------------------------------
City | ROSLINDALE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02131-4844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-407-6750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21B CHARLES ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02472-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 13377
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------