Provider Demographics
NPI:1033100656
Name:LLACERA KLEIN, JODI A (MS DPT OCS)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:A
Last Name:LLACERA KLEIN
Suffix:
Gender:F
Credentials:MS DPT OCS
Other - Prefix:
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Mailing Address - Street 1:40 BEACH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1468
Mailing Address - Country:US
Mailing Address - Phone:978-526-8288
Mailing Address - Fax:978-526-7084
Practice Address - Street 1:40 BEACH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1468
Practice Address - Country:US
Practice Address - Phone:978-526-8288
Practice Address - Fax:978-526-7084
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA61282251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66335Medicare ID - Type UnspecifiedPHYSICAL THERAPIST