Kathleen Bannon
Individual provider Active NPI Physical Therapist · Stoneham, MA
NPI 1649711987 · NPPES record last updated Jul 24, 2017
Key facts
- NPI
- 1649711987
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11469 (MA)
- Practice address
- 92 Montvale Ave Ste 4500
Stoneham, MA 02180-3663 - Phone
- (781) 279-8433
- NPI assigned
- Mar 20, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11469 | MA | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11469 | MA | Yes |
Addresses
Primary practice location
92 Montvale Ave Ste 4500
Stoneham, MA 02180-3663
Mailing address
92 Montvale Ave
Ste 4500
Stoneham, MA 02180-3663
Phone (617) 851-9615
Other providers in Stoneham, MA
- Michael Bader
- Nora Baghdad
- Tomer Bahar
- Audra L Bake
- Sangeeta Banerjee
- Elizabeth Banquer
- Vita Baranauskas
- Courtney Kathleen Barresi
- Larah Bartlett-Jacques
- Leslie F Bass
All providers in Stoneham, MA · Physical Therapist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.