Provider Demographics
NPI:1073635066
Name:MASTERS, QUERIDA FANELLI (PTA)
Entity Type:Individual
Prefix:MS
First Name:QUERIDA
Middle Name:FANELLI
Last Name:MASTERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BOLTON RD
Mailing Address - Street 2:
Mailing Address - City:ROYALSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01368-8954
Mailing Address - Country:US
Mailing Address - Phone:978-249-2281
Mailing Address - Fax:
Practice Address - Street 1:130 COLRAIN RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-9625
Practice Address - Country:US
Practice Address - Phone:413-774-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2111225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant