Provider Demographics
NPI:1609355288
Name:TOUCH, MONGSEYLA
Entity Type:Individual
Prefix:
First Name:MONGSEYLA
Middle Name:
Last Name:TOUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 GREAT RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2737
Mailing Address - Country:US
Mailing Address - Phone:781-275-8400
Mailing Address - Fax:781-275-8401
Practice Address - Street 1:158 GREAT RD UNIT C
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2737
Practice Address - Country:US
Practice Address - Phone:781-275-8400
Practice Address - Fax:781-275-8401
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist