Provider Demographics
NPI:1871837245
Name:AVISATA, DENISE (PT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:AVISATA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9715
Mailing Address - Country:US
Mailing Address - Phone:413-584-5057
Mailing Address - Fax:
Practice Address - Street 1:20 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9715
Practice Address - Country:US
Practice Address - Phone:413-584-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist