Provider Demographics
NPI:1033468335
Name:DODGE-KRUPA, NOVALEIGH (PT)
Entity Type:Individual
Prefix:MRS
First Name:NOVALEIGH
Middle Name:
Last Name:DODGE-KRUPA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2758
Mailing Address - Country:US
Mailing Address - Phone:617-335-9018
Mailing Address - Fax:
Practice Address - Street 1:162 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2758
Practice Address - Country:US
Practice Address - Phone:617-335-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist