Provider Demographics
NPI:1760769830
Name:BROWN, LISA (PT, DPT, NCS,)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT, NCS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1305
Mailing Address - Country:US
Mailing Address - Phone:617-353-2304
Mailing Address - Fax:617-353-9463
Practice Address - Street 1:635 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1605
Practice Address - Country:US
Practice Address - Phone:617-353-2304
Practice Address - Fax:617-353-9463
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist