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General NPI Number Information
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NPI Number | 1962058289
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Entity Type | Individual
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Provider Name | ERIN BROOKE DONNELLY PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 161 COLLEGE AVE
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City | MEDFORD
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State | MA
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Zip | 02155-5593
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Country | US
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Telephone | 781-874-9748
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Fax | 617-627-2185
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Provider Business Mailing Address
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Address Line | 161 COLLEGE AVE
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City | MEDFORD
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State | MA
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Zip | 02155-5593
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Country | US
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Telephone | 781-874-9748
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Fax | 617-627-2185
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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 | 24520
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License Number State | MA
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