Provider Demographics
NPI:1235361346
Name:MCKENNA REINACH, ELIZABETH (ATC, MPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCKENNA REINACH
Suffix:
Gender:F
Credentials:ATC, MPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC, MPT
Mailing Address - Street 1:5 NIPMUCK DR
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3363
Mailing Address - Country:US
Mailing Address - Phone:508-616-6980
Mailing Address - Fax:
Practice Address - Street 1:1078 W BOYLSTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1167
Practice Address - Country:US
Practice Address - Phone:508-852-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-23
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120552251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports