Provider Demographics
NPI:1659615003
Name:LASCOLA, TARA CRISTELLE (MMP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:CRISTELLE
Last Name:LASCOLA
Suffix:
Gender:F
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-49 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4375
Mailing Address - Country:US
Mailing Address - Phone:978-278-3310
Mailing Address - Fax:
Practice Address - Street 1:47-49 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4375
Practice Address - Country:US
Practice Address - Phone:978-278-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2875225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2875OtherSTATE OF MA