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NPI Code Detail

MEDICARE: MS. LISA PATRICIA HUGHES MS, ATC-L, LMT

MEDICARE: MS. LISA PATRICIA HUGHES MS, ATC-L, LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer000167CT

General Provider Information

NPI Number : 1134322761
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA PATRICIA HUGHES MS, ATC-L, LMT
Provider Business Mailing Address
First Line : 117 SHADOW LN
Second Line :
City : WEST HARTFORD
State : CT
Zip : 06110-1668
Country : US
Telephone Number : 860-874-3501
Fax Number :
Provider Business Practice Location Address
First Line : 20 ISHAM RD
Second Line :
City : WEST HARTFORD
State : CT
Zip : 06107-2204
Country : US
Telephone Number : 860-761-1083
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2007
Last Update Date : 07/08/2007

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