Provider Demographics
NPI:1134322761
Name:HUGHES, LISA PATRICIA (MS, ATC-L, LMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:PATRICIA
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MS, ATC-L, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1668
Mailing Address - Country:US
Mailing Address - Phone:860-874-3501
Mailing Address - Fax:
Practice Address - Street 1:20 ISHAM RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2204
Practice Address - Country:US
Practice Address - Phone:860-761-1083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer