Provider Demographics
NPI:1659452167
Name:VEDDER, LISA M (LMT, DIPL ABT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:VEDDER
Suffix:
Gender:F
Credentials:LMT, DIPL ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5732
Mailing Address - Country:US
Mailing Address - Phone:617-547-2700
Mailing Address - Fax:617-547-2701
Practice Address - Street 1:127 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5732
Practice Address - Country:US
Practice Address - Phone:617-547-2700
Practice Address - Fax:617-547-2701
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist