Provider Demographics
NPI:1982726477
Name:LISA M VELARDO, MUSCULAR THERAPY
Entity Type:Organization
Organization Name:LISA M VELARDO, MUSCULAR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VELARDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:781-599-2661
Mailing Address - Street 1:161 EASTERN AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1307
Mailing Address - Country:US
Mailing Address - Phone:781-599-2661
Mailing Address - Fax:781-284-8832
Practice Address - Street 1:161 EASTERN AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-1307
Practice Address - Country:US
Practice Address - Phone:781-599-2661
Practice Address - Fax:781-284-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMI2005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty