Provider Demographics
NPI:1811415086
Name:PEDRICK, MICAYLA BRIANNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICAYLA
Middle Name:BRIANNE
Last Name:PEDRICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3127
Mailing Address - Country:US
Mailing Address - Phone:862-432-5937
Mailing Address - Fax:
Practice Address - Street 1:220 BEAR HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1004
Practice Address - Country:US
Practice Address - Phone:781-790-8479
Practice Address - Fax:781-281-9181
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230382251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics