Healthcare Provider Details

I. General information

NPI: 1932989860
Provider Name (Legal Business Name): LAILA TOKATLI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 SHREWSBURY ST STE 1
BOYLSTON MA
01505-1701
US

IV. Provider business mailing address

PO BOX 1110
BOYLSTON MA
01505-1810
US

V. Phone/Fax

Practice location:
  • Phone: 774-614-1322
  • Fax: 774-614-1171
Mailing address:
  • Phone: 774-614-1322
  • Fax: 774-614-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24335
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: