Basic Information
| Provider Information | |||||||||
| NPI: | 1598864696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADILI SKINNER | ||||||||
| FirstName: | MARIAM | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1913 COMMONWEALTH AVE | ||||||||
| Address2: | |||||||||
| City: | AUBURNDALE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024662417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177305337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1180 BEACON ST | ||||||||
| Address2: | SUITE 6C | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024463885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177305337 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 04/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 16020 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Y38139 | 01 | MA | BC | OTHER | 3138008 | 01 | MA | ATENA | OTHER | 470287 | 01 | MA | TUFTS | OTHER |