Provider Demographics
NPI:1356559165
Name:DOUGLAS, PRISCILLA LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:LYNN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PRISCILLA
Other - Middle Name:LYNN
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:387 QUARRY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1026
Mailing Address - Country:US
Mailing Address - Phone:508-324-9300
Mailing Address - Fax:508-324-9309
Practice Address - Street 1:387 QUARRY ST STE 102
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723
Practice Address - Country:US
Practice Address - Phone:508-324-9300
Practice Address - Fax:508-324-9309
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist