Provider Demographics
NPI:1821610908
Name:LISA MUNROE, DPT, PLLC
Entity Type:Organization
Organization Name:LISA MUNROE, DPT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:774-722-2168
Mailing Address - Street 1:22 SMALLWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-2100
Mailing Address - Country:US
Mailing Address - Phone:774-722-2168
Mailing Address - Fax:
Practice Address - Street 1:22 SMALLWOOD CIR
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-2100
Practice Address - Country:US
Practice Address - Phone:774-722-2168
Practice Address - Fax:888-981-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty