Provider Demographics
NPI:1336816776
Name:NUSSDORFER, ELIZA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:NUSSDORFER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:
Other - Last Name:READ-BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:501 JOHN MAHAR HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-6563
Mailing Address - Country:US
Mailing Address - Phone:781-384-0500
Mailing Address - Fax:781-848-0501
Practice Address - Street 1:501 JOHN MAHAR HWY STE 301
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6563
Practice Address - Country:US
Practice Address - Phone:781-384-0500
Practice Address - Fax:781-848-0501
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist