Provider Demographics
NPI:1740310242
Name:JODI A LLACERA KLEIN
Entity type:Organization
Organization Name:JODI A LLACERA KLEIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-526-8288
Mailing Address - Street 1:40 BEACH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1468
Mailing Address - Country:US
Mailing Address - Phone:978-526-8288
Mailing Address - Fax:978-526-7084
Practice Address - Street 1:40 BEACH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1468
Practice Address - Country:US
Practice Address - Phone:978-526-8288
Practice Address - Fax:978-526-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty