Individual
ITUA EGHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
356 THIRD ST, CAMBRIDGE, MA 02142-1111
(617) 714-5402
(844) 912-8604
Mailing address
4 RICHMOND SQ, PROVIDENCE, RI 02906-5117
(401) 433-4172
(401) 433-0612
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
26933
MA
Other
Enumeration date
09/20/2023
Last updated
10/16/2025
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