Provider Demographics
NPI:1992711998
Name:AZAR, KAREN A (MSPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:AZAR
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 1:618 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7335
Mailing Address - Country:US
Mailing Address - Phone:617-770-1696
Mailing Address - Fax:617-770-0335
Practice Address - Street 1:618 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7335
Practice Address - Country:US
Practice Address - Phone:617-770-1696
Practice Address - Fax:617-770-0335
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69026Medicare ID - Type Unspecified