Provider Demographics
NPI:1255624920
Name:ANGELUCCI, LISA JANINE (NCBTMB)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:JANINE
Last Name:ANGELUCCI
Suffix:
Gender:F
Credentials:NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-9209
Mailing Address - Country:US
Mailing Address - Phone:610-327-8090
Mailing Address - Fax:610-327-0970
Practice Address - Street 1:1954 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9209
Practice Address - Country:US
Practice Address - Phone:610-327-8090
Practice Address - Fax:610-327-0970
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001577225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist