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NPI Code Detail

MEDICARE: MRS. JUSTINE SMITH RPT

MEDICARE: MRS. JUSTINE SMITH RPT
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 Therapist15217MA

General Provider Information

NPI Number : 1457899593
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUSTINE SMITH RPT
Provider Business Mailing Address
First Line : 12 CROOKS RD
Second Line :
City : NORTH BROOKFIELD
State : MA
Zip : 01535-2018
Country : US
Telephone Number : 508-612-9271
Fax Number :
Provider Business Practice Location Address
First Line : 1369 GRAFTON ST
Second Line :
City : WORCESTER
State : MA
Zip : 01604-2737
Country : US
Telephone Number : 508-373-7437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2017
Last Update Date : 02/09/2017

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Directions to “ MRS. JUSTINE SMITH RPT” Practice Location

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