Provider Demographics
NPI:1184763997
Name:BIONDI, BEVERLY ANN (PT)
Entity type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:ANN
Last Name:BIONDI
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 1:86 THE TIDES CT
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631
Mailing Address - Country:US
Mailing Address - Phone:508-241-5373
Mailing Address - Fax:508-896-2873
Practice Address - Street 1:84 UNDERPASS RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631
Practice Address - Country:US
Practice Address - Phone:508-241-5373
Practice Address - Fax:508-896-2873
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4988225100000X
CAPT12163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA626564OtherHARVARD PILGRIM
MA626564OtherHARVARD PILGRIM