Most Relevant Information
Provider Data
| NPI Number: | 1003457813 |
| Provider Name: | RICHARD LONG |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 24456 |
Most Important Dates
| Enumeration Date: | 10/02/2019 |
| Last Updated: | 10/02/2019 |
Provider Practice Location
960 WILLIAM T MORRISSEY BLVD
DORCHESTER
MA
021223206
Practice Location Phone/Fax
| Phone: | 6175067210 |
| Fax: |
Provider Mailing Location
960 WILLIAM T MORRISSEY BLVD
DORCHESTER
MA
021223206
Provider Mailing Phone/Fax
| Phone: | 6175067210 |
| Fax: |