Provider Demographics
NPI:1457629321
Name:PRIFTI, KERRY (PT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:PRIFTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1273
Mailing Address - Country:US
Mailing Address - Phone:617-771-6860
Mailing Address - Fax:
Practice Address - Street 1:35 TREMONT ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1273
Practice Address - Country:US
Practice Address - Phone:617-771-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist