Provider Demographics
NPI:1497939391
Name:EATOUGH, LISA CATHERINE IAFRATE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CATHERINE IAFRATE
Last Name:EATOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CATHERINE
Other - Last Name:IAFRATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 PEARL STREET
Mailing Address - Street 2:EARLY INTERVENTION
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-280-4438
Mailing Address - Fax:
Practice Address - Street 1:83 PEARL STREET
Practice Address - Street 2:EARLY INTERVENTION
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-280-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist