Individual
MS. KATIE L BRESNAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
111 HEADWATERS DR, HARWICH, MA 02645-1028
(508) 430-1717
Mailing address
111 HEADWATERS DRIVE, HARWICH, MA 02645
(508) 430-1717
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17328
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0708666
—
MA
01
—
494365
TUFTS
MA
01
—
90878
FALLON
MA
01
—
Y68495
BLUE SHIELD
MA
Enumeration date
02/10/2006
Last updated
06/08/2016
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