Provider Demographics
NPI:1851333413
Name:LACANDULA, NEIL (PT)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:
Last Name:LACANDULA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 ALLERTON COMMONS LN
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-8248
Mailing Address - Country:US
Mailing Address - Phone:781-308-3324
Mailing Address - Fax:
Practice Address - Street 1:187 ALLERTON COMMONS LN
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-8248
Practice Address - Country:US
Practice Address - Phone:781-308-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist