MEDICARE: MR. NIJE J RIBOTTO MSPT

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	13027	MA

General Provider Information

NPI Number	:	1801030895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NIJE J RIBOTTO MSPT

Provider Business Mailing Address
First Line	:	75 WEBSTER ST
Second Line	:	#2
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-2708
Country	:	US
Telephone Number	:	617-319-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 WEBSTER ST
Second Line	:	#2
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-2708
Country	:	US
Telephone Number	:	617-319-2611
Fax Number	:

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

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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