Provider Demographics
NPI:1962909911
Name:PADRENOSS, JOAN ELIZABETH (PTA)
Entity type:Individual
Prefix:MISS
First Name:JOAN
Middle Name:ELIZABETH
Last Name:PADRENOSS
Suffix:
Gender:F
Credentials:PTA
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Mailing Address - Street 1:144 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-2317
Mailing Address - Country:US
Mailing Address - Phone:508-678-0283
Mailing Address - Fax:
Practice Address - Street 1:165 COURT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-4608
Practice Address - Country:US
Practice Address - Phone:508-897-0007
Practice Address - Fax:508-897-0020
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4211225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4211OtherPHYSICAL THERAPY ASSISTANT