Provider Demographics
NPI:1710111737
Name:MASSUCCI, MONA LISA (PTA)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:LISA
Last Name:MASSUCCI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2214
Mailing Address - Country:US
Mailing Address - Phone:330-399-4000
Mailing Address - Fax:330-399-4015
Practice Address - Street 1:5500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2214
Practice Address - Country:US
Practice Address - Phone:330-399-4000
Practice Address - Fax:330-399-4015
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2080427225200000X
OHPTA-04852225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant