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NPI Code Detail

MEDICARE: DARRYL ELLIOTT PT

MEDICARE: DARRYL ELLIOTT PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist8390MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y66829OTHERMABCBS

General Provider Information

NPI Number : 1053337006
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARRYL ELLIOTT PT
Provider Business Mailing Address
First Line : 535 S MAIN ST
Second Line :
City : RANDOLPH
State : MA
Zip : 02368-5254
Country : US
Telephone Number : 781-961-3370
Fax Number : 781-767-7531
Provider Business Practice Location Address
First Line : 75 FINNELL DR
Second Line :
City : WEYMOUTH
State : MA
Zip : 02188-1110
Country : US
Telephone Number : 781-335-1151
Fax Number : 781-335-7851
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 12/01/2008

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