Provider Demographics
NPI:1407213408
Name:MASSA, ANDREA (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:MASSA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:MASSA-WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:20 EAST ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1638
Mailing Address - Country:US
Mailing Address - Phone:781-826-8309
Mailing Address - Fax:
Practice Address - Street 1:20 EAST ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1638
Practice Address - Country:US
Practice Address - Phone:781-826-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist