Basic Information
| Provider Information | |||||||||
| NPI: | 1376820779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLDUC | ||||||||
| FirstName: | KATHARINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 E COLUMBUS AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011052509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133016019 | ||||||||
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| Practice Location | |||||||||
| Address1: | 933 E COLUMBUS AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011052509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133016019 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2011 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 19655 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.