Provider Demographics
NPI:1619093408
Name:BRIGGS, MARY ROSE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ROSE
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20C DEL CARMINE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3464
Mailing Address - Country:US
Mailing Address - Phone:781-334-2427
Mailing Address - Fax:781-334-7079
Practice Address - Street 1:20C DEL CARMINE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3464
Practice Address - Country:US
Practice Address - Phone:781-334-2427
Practice Address - Fax:781-334-7079
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2393225100000X
NH2107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65750OtherBLUE CROSS BLUE SHIELD
MA797453OtherTUFTS HEALH PLAN