Individual
MRS. KATHLEEN G FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT/PT
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-7212
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-7212
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17931
MA
Other
Enumeration date
11/28/2007
Last updated
03/08/2010
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