Individual
MR. DECLAN E FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
16 SYCAMORE RD, BRAINTREE, MA 02184-7308
(617) 333-8389
Mailing address
16 SYCAMORE RD, BRAINTREE, MA 02184-7308
(617) 333-8389
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13347
MA
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102302300
ACS
MA
01
—
458473
TUFTS HEALTH PLAN
MA
01
—
603413
HARVARD PILGRIM
MA
01
—
6440025
UNITED HEALTHCARE
MA
01
—
8211
NEIGHBORHOOD HEALTH PLAN
MA
01
—
Y67710
BLUE CROSS
MA
Enumeration date
06/05/2006
Last updated
03/07/2023
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