Provider Demographics
NPI:1609070481
Name:MACDONNELL, LISA ANN (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MACDONNELL
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 1:2 HARLEY LN
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1253
Mailing Address - Country:US
Mailing Address - Phone:508-543-0853
Mailing Address - Fax:
Practice Address - Street 1:751 GRANITE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5328
Practice Address - Country:US
Practice Address - Phone:781-380-4360
Practice Address - Fax:781-356-1820
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist