Provider Demographics
NPI:1396163788
Name:VANDERGRIFT, ELEANOR (PTA)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:
Last Name:VANDERGRIFT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TARA CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3446
Mailing Address - Country:US
Mailing Address - Phone:413-588-6770
Mailing Address - Fax:
Practice Address - Street 1:15 TARA CIR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3446
Practice Address - Country:US
Practice Address - Phone:413-588-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3515225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant