Healthcare Provider Details

I. General information

NPI: 1912105115
Provider Name (Legal Business Name): RICHARD LAPRESTE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 MECHANIC ST
FOXBORO MA
02035-2012
US

IV. Provider business mailing address

67 MECHANIC ST
FOXBORO MA
02035-2012
US

V. Phone/Fax

Practice location:
  • Phone: 508-203-9350
  • Fax: 508-203-9355
Mailing address:
  • Phone: 508-541-9111
  • Fax: 508-541-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17975
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: