Provider Demographics
NPI:1093376071
Name:VALLIE, CAMERON JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:JAMES
Last Name:VALLIE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 MASS AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3739
Mailing Address - Country:US
Mailing Address - Phone:978-263-0007
Mailing Address - Fax:978-263-0014
Practice Address - Street 1:191 HARTWELL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2425
Practice Address - Country:US
Practice Address - Phone:781-275-4111
Practice Address - Fax:781-275-0884
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic