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General NPI Number Information
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NPI Number | 1164741336
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Entity Type | Individual
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Provider Name | PAULO LAGE PTA, LMT
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Gender | Male
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 1820 TURNPIKE ST STE 200
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-6327
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Country | US
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Telephone | 617-312-0204
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Fax |
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Provider Business Mailing Address
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Address Line | 2 EDGEWOOD DR
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City | HUDSON
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State | MA
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Zip | 01749-1209
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Country | US
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Telephone | 617-312-0204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 8351
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 6397
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License Number State | MA
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