Individual
BRENDA JEAN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
59 BABCOCK TAVERN RD, WARE, MA 01082-9509
(413) 067-7741
Mailing address
59 BABCOCK TAVERN RD, WARE, MA 01082-9509
(413) 067-7741
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
18547
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18547
DIVISION OF PROFESSIONAL LICENSURE BOARD OF ALLIED HEALTH PROFESSIONS
MA
Enumeration date
03/16/2012
Last updated
03/16/2012
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