Provider Demographics
NPI:1982628343
Name:VESPA, LYNN A (PT)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:A
Last Name:VESPA
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 1:382 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3466
Mailing Address - Country:US
Mailing Address - Phone:508-842-4500
Mailing Address - Fax:508-842-9135
Practice Address - Street 1:382 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3466
Practice Address - Country:US
Practice Address - Phone:508-842-4500
Practice Address - Fax:508-842-9135
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA50588OtherHARVARD PILGRIM HEALTH CA
MAY65425OtherBLUE SHIELD
MAY65425OtherBLUE SHIELD