Provider Demographics
NPI:1013520881
Name:LISA SCIALLA DPT, PLLC
Entity Type:Organization
Organization Name:LISA SCIALLA DPT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:617-485-8367
Mailing Address - Street 1:64 BROOKS AVE # 2
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1508
Mailing Address - Country:US
Mailing Address - Phone:617-968-3999
Mailing Address - Fax:617-322-9281
Practice Address - Street 1:377 W BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2217
Practice Address - Country:US
Practice Address - Phone:617-485-8367
Practice Address - Fax:617-322-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy