Provider Demographics
NPI:1659669174
Name:LACSON, MYLA S (RPT)
Entity Type:Individual
Prefix:MS
First Name:MYLA
Middle Name:S
Last Name:LACSON
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 1:169 NORTON AVE
Mailing Address - Street 2:APT3
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1229
Mailing Address - Country:US
Mailing Address - Phone:732-318-1776
Mailing Address - Fax:
Practice Address - Street 1:169 NORTON AVE
Practice Address - Street 2:APT3
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1229
Practice Address - Country:US
Practice Address - Phone:732-318-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist