Basic Information
| Provider Information | |||||||||
| NPI: | 1598791402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLAHERTY | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 LINWOOD AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WHITINSVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015882068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082347544 | ||||||||
| FaxNumber: | 5082348002 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 LINWOOD AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WHITINSVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015882068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082347544 | ||||||||
| FaxNumber: | 5082348002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8633 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 468163 | 01 | MA | TUFTS | OTHER | Y66981 | 01 | MA | BCBS | OTHER |