Provider Demographics
NPI:1962885418
Name:DAUTOVIC, SABINA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:SABINA
Middle Name:
Last Name:DAUTOVIC
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N SHORE RD
Mailing Address - Street 2:APT 407
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1617
Mailing Address - Country:US
Mailing Address - Phone:978-741-5700
Mailing Address - Fax:
Practice Address - Street 1:190 N SHORE RD
Practice Address - Street 2:APT 407
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1617
Practice Address - Country:US
Practice Address - Phone:978-741-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist