Provider Demographics
NPI:1417012626
Name:MCHUGH, LALLA SARGENT (PT)
Entity Type:Individual
Prefix:MS
First Name:LALLA
Middle Name:SARGENT
Last Name:MCHUGH
Suffix:
Gender:F
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 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1611
Mailing Address - Country:US
Mailing Address - Phone:617-549-7586
Mailing Address - Fax:617-323-4221
Practice Address - Street 1:140 WOOD RD STE 405E
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2515
Practice Address - Country:US
Practice Address - Phone:781-519-4756
Practice Address - Fax:781-519-4757
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68742Medicare ID - Type Unspecified