Provider Demographics
NPI:1649409517
Name:LASANTE, JULIA (PT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:LASANTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 MADIGAN LN
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1164
Mailing Address - Country:US
Mailing Address - Phone:978-501-6483
Mailing Address - Fax:
Practice Address - Street 1:325 AYER RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1132
Practice Address - Country:US
Practice Address - Phone:978-772-8100
Practice Address - Fax:978-722-8102
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008509225100000X
MA19474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist