Provider Demographics
NPI:1487816526
Name:MACKIRDY, KATHERINE S
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:MACKIRDY
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 1:694 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-2837
Mailing Address - Country:US
Mailing Address - Phone:781-237-6400
Mailing Address - Fax:781-489-6109
Practice Address - Street 1:694 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-2837
Practice Address - Country:US
Practice Address - Phone:781-237-6400
Practice Address - Fax:781-489-6109
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist