1013683978 NPI number — KATHRYN ELIZABETH AMORIN DPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013683978 NPI number — KATHRYN ELIZABETH AMORIN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMORIN
Provider First Name:
KATHRYN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013683978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 MASS AVE STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01720-3739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-263-0007
Provider Business Mailing Address Fax Number:
978-263-0014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10211 ARBOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01545-6041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-954-2080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  25712 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)