Provider Demographics
NPI:1144292541
Name:DUDDY, ALICE SAWYER (PT)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:SAWYER
Last Name:DUDDY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 WINCH ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-877-8401
Mailing Address - Fax:508-877-6997
Practice Address - Street 1:60 NICHOLAS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3487
Practice Address - Country:US
Practice Address - Phone:774-279-1243
Practice Address - Fax:508-877-6997
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH4919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
314J593OtherAETNA
MA0036620OtherNHP
723G169OtherAETNA
6400683OtherUHC
MAAA10737OtherHARVARD PILGRIM
MA0370533Medicaid
MAY65982OtherBCBS
MADUY68655Medicare ID - Type Unspecified