Healthcare Provider Details

I. General information

NPI: 1053565408
Provider Name (Legal Business Name): LISA VIVEIROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 CENTER ST
NORTH DIGHTON MA
02764-1710
US

IV. Provider business mailing address

161 MOUNTFAIR CIRCLE
SWANSEA MA
02777-1000
US

V. Phone/Fax

Practice location:
  • Phone: 508-669-6741
  • Fax:
Mailing address:
  • Phone: 508-674-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6030
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0929
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA00474
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: