Provider Demographics
NPI:1295958668
Name:GREATHEAD, MARY LISA (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LISA
Last Name:GREATHEAD
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 1:27 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4164
Mailing Address - Country:US
Mailing Address - Phone:978-989-9210
Mailing Address - Fax:
Practice Address - Street 1:27 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4164
Practice Address - Country:US
Practice Address - Phone:978-989-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4434PT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist