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NPI Code Detail

MEDICARE: DENIVELISSE VEGA PT, DPT

MEDICARE: DENIVELISSE VEGA PT, DPT
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
1225100000XPhysical Therapist27152MA

General Provider Information

NPI Number : 1700661097
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENIVELISSE VEGA PT, DPT
Provider Business Mailing Address
First Line : 52 N ASHLAND ST
Second Line :
City : WORCESTER
State : MA
Zip : 01609-3019
Country : US
Telephone Number : 508-825-4535
Fax Number :
Provider Business Practice Location Address
First Line : 93 STAFFORD ST
Second Line :
City : WORCESTER
State : MA
Zip : 01603-1459
Country : US
Telephone Number : 508-593-1890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 10/21/2025

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Directions to “ DENIVELISSE VEGA PT, DPT” Practice Location

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