Provider Demographics
NPI:1164871661
Name:POLIGNONE, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:POLIGNONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4735
Mailing Address - Country:US
Mailing Address - Phone:781-289-3533
Mailing Address - Fax:
Practice Address - Street 1:214 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6716
Practice Address - Country:US
Practice Address - Phone:781-321-0645
Practice Address - Fax:781-321-0679
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist