Provider Demographics
NPI:1861540023
Name:HENRY-MACDONALD, MARTHA ANNE (PT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:HENRY-MACDONALD
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 1:135 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2708
Mailing Address - Country:US
Mailing Address - Phone:508-359-2660
Mailing Address - Fax:508-359-2660
Practice Address - Street 1:135 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2708
Practice Address - Country:US
Practice Address - Phone:508-359-2660
Practice Address - Fax:508-359-2660
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA766109OtherTUFTS HEALTH PLAN
MAY66045OtherBLUE CROSS AND BLUE SHIEL