MEDICARE: MRS. MARYBETH GRIFFITH 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
1	225100000X	Physical Therapist	16114	MA

General Provider Information

NPI Number	:	1376618074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYBETH GRIFFITH PT

Provider Business Mailing Address
First Line	:	12 CALVIN ST
Second Line	:
City	:	AYER
State	:	MA
Zip	:	01432-1578
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 AYER RD
Second Line	:
City	:	HARVARD
State	:	MA
Zip	:	01451-1132
Country	:	US
Telephone Number	:	617-772-8100
Fax Number	:

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	12/12/2016

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