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General NPI Number Information
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NPI Number | 1972159226
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Entity Type | Organization
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Legal Business Name | LIVE GOOD, FEEL GOOD LLC
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 380 WASHINGTON ST # 2C
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City | BRIGHTON
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State | MA
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Zip | 02135-2968
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Country | US
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Telephone | 516-318-6627
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Fax |
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Provider Business Mailing Address
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Address Line | 14 BENNETT ST
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City | BRIGHTON
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State | MA
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Zip | 02135-2703
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Country | US
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Telephone | 516-318-6627
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KERRY E MCGINN
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Credential | PT, DPT
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Telephone | 516-318-6627
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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 |
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License Number State |
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