Individual
MS. STACEY LYNN RODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
854 DORCHESTER AVE, UNIT#1, DORCHESTER, MA 02125-1133
(617) 265-3735
Mailing address
854 DORCHESTER AVE, UNIT#1, DORCHESTER, MA 02125-1133
(617) 265-3735
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3716
MA
Other
Enumeration date
04/19/2007
Last updated
07/08/2007
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