Individual
AMANDA FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-4724
Mailing address
800 WASHINGTON ST, BOSTON, MA 02111-1552
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
21878
MA
Other
Enumeration date
04/13/2016
Last updated
04/13/2016
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