Provider Demographics
NPI:1568895928
Name:BURILLO, ALICIA JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:BURILLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CREDIT UNION WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4633
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:156 ANDOVER ST UNIT 2
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1468
Practice Address - Country:US
Practice Address - Phone:978-767-8343
Practice Address - Fax:978-767-8349
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361401225100000X
MA21382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4731307OtherAETNA
MA110110058AMedicaid
MA1233079OtherAMERICAN SPECIALTY HEALTH (ASHCIGNA)
MA233423OtherTUFTS HEALTH PLANS- COMMERCIAL PLANS
MA877138OtherOPTUM/UNITED HEALTH CARE