1962909911 NPI number — MISS JOAN ELIZABETH PADRENOSS PTA

Table of content: MISS JOAN ELIZABETH PADRENOSS PTA (NPI 1962909911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962909911 NPI number — MISS JOAN ELIZABETH PADRENOSS PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADRENOSS
Provider First Name:
JOAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1962909911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 PINEHURST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANSEA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02777-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-678-0283
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02302-4608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-897-0007
Provider Business Practice Location Address Fax Number:
508-897-0020
Provider Enumeration Date:
04/06/2018

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: 225200000X , with the licence number:  4211 , 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)

  • Identifier: 4211 . This is a "PHYSICAL THERAPY ASSISTANT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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