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General NPI Number Information
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NPI Number | 1952835480
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Entity Type | Organization
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Legal Business Name | SMB THERAPY
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 19 PRINCE RD
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City | CHARLTON
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State | MA
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Zip | 01507-5117
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Country | US
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Telephone | 774-402-0552
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PRINCE RD
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City | CHARLTON
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State | MA
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Zip | 01507-5117
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Country | US
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Telephone | 774-402-0552
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | SUSAN AMANDA MURRAY-BLAKE
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Credential | PT, RMT
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Telephone | 774-402-0552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 17540
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License Number State | MA
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