Provider Demographics
NPI:1043857592
Name:SANDBERG, LISA JEAN (MSPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:SANDBERG
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 1:355 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2059
Mailing Address - Country:US
Mailing Address - Phone:781-696-9550
Mailing Address - Fax:
Practice Address - Street 1:222 FORBES RD
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2706
Practice Address - Country:US
Practice Address - Phone:781-356-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist