Provider Demographics
NPI:1518325000
Name:ADAMS, LISA (DPT, MHP, CDT, CEEAA)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DPT, MHP, CDT, CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 KING ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3007
Mailing Address - Country:US
Mailing Address - Phone:781-698-9556
Mailing Address - Fax:
Practice Address - Street 1:76 KING ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3007
Practice Address - Country:US
Practice Address - Phone:781-698-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA90502251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist