Provider Demographics
NPI:1619023637
Name:LUZARRAGA, VICTORIA (RPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LUZARRAGA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16A PACKARDS LN
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4946
Mailing Address - Country:US
Mailing Address - Phone:617-770-4921
Mailing Address - Fax:617-734-3535
Practice Address - Street 1:51 WATER ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4603
Practice Address - Country:US
Practice Address - Phone:617-734-3535
Practice Address - Fax:617-734-3535
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68524Medicare ID - Type Unspecified