Provider Demographics
NPI:1902232812
Name:BRUNOLI, KARISSA LEIGH (PTA)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:LEIGH
Last Name:BRUNOLI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BASKIN LN
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1532
Mailing Address - Country:US
Mailing Address - Phone:413-672-2530
Mailing Address - Fax:
Practice Address - Street 1:4 BASKIN LN
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1532
Practice Address - Country:US
Practice Address - Phone:413-672-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8767225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant