Provider Demographics
NPI:1619194917
Name:FLAHERTY, SEAN M (PT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:FLAHERTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 COMMERCIAL ST
Mailing Address - Street 2:#115
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1295
Mailing Address - Country:US
Mailing Address - Phone:781-858-8107
Mailing Address - Fax:
Practice Address - Street 1:385 BROADWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3033
Practice Address - Country:US
Practice Address - Phone:781-485-1001
Practice Address - Fax:781-485-1003
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA109482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69425Medicare ID - Type Unspecified