Provider Demographics
NPI:1407151236
Name:LACANDULA, MOISES CABRAS JR (PT)
Entity Type:Individual
Prefix:MR
First Name:MOISES
Middle Name:CABRAS
Last Name:LACANDULA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LEO EGAN WAY
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3229
Mailing Address - Country:US
Mailing Address - Phone:781-535-8267
Mailing Address - Fax:
Practice Address - Street 1:125 BROAD ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2336
Practice Address - Country:US
Practice Address - Phone:781-337-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18503225100000X
CO8487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist