Provider Demographics
NPI:1740414564
Name:TROY, LISA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA ANN
Middle Name:
Last Name:TROY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LISA ANN
Other - Middle Name:
Other - Last Name:IMBARRATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2 MADISON ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-4117
Mailing Address - Country:US
Mailing Address - Phone:978-337-6224
Mailing Address - Fax:978-988-5513
Practice Address - Street 1:2 MADISON ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-4117
Practice Address - Country:US
Practice Address - Phone:978-337-6224
Practice Address - Fax:978-988-5513
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist