Provider Demographics
NPI:1861476780
Name:DEVIN, JOANNE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:DEVIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 BOLIVAR ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3102
Mailing Address - Country:US
Mailing Address - Phone:781-821-6595
Mailing Address - Fax:508-583-1138
Practice Address - Street 1:85 MILL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5587
Practice Address - Country:US
Practice Address - Phone:508-583-4884
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0349445Medicaid
MA0349445Medicaid