Healthcare Provider Details

I. General information

NPI: 1659452167
Provider Name (Legal Business Name): LISA M. VEDDER L.M.T., DIPL. A.B.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5732
US

IV. Provider business mailing address

127 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5732
US

V. Phone/Fax

Practice location:
  • Phone: 617-547-2700
  • Fax: 617-547-2701
Mailing address:
  • Phone: 617-547-2700
  • Fax: 617-547-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: