MEDICARE: ELISA ROSE CHRISTENSEN STONE PT, DPT

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
1	225100000X	Physical Therapist	24657	MA

General Provider Information

NPI Number	:	1144869751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA ROSE CHRISTENSEN STONE PT, DPT

Provider Business Mailing Address
First Line	:	1 CITYVIEW LN UNIT 307
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-4676
Country	:	US
Telephone Number	:	860-508-2049
Fax Number	:

Provider Business Practice Location Address
First Line	:	479 WASHINGTON ST STE 50
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-5895
Country	:	US
Telephone Number	:	617-536-1161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	01/11/2022

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