Provider Demographics
NPI:1750807517
Name:DIGIAMMARINO, KELLY ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ALLEN
Last Name:DIGIAMMARINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2411
Mailing Address - Country:US
Mailing Address - Phone:203-767-1608
Mailing Address - Fax:
Practice Address - Street 1:16 GRAND ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2411
Practice Address - Country:US
Practice Address - Phone:203-767-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA18394OtherPHYSICAL THERAPY LICENSE