Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 10540 | MA |
NPI | 1326686825 |
---|---|
Provider Name | Lisa Marie Villa |
First Address | Bellingham, MA 02019 |
Second Address | Milford, MA 01757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2019 |
Last Update Date | 16/12/2019 |