Doctor Name: | MS. LISA PACIFICO |
NPI Number: | 1417351156 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.T. |
License Number: | 007696 |
Business Practice Address: | 44 Maritime Dive Mystic, CT - 06355 |
Business Phone Number: | 8605721700 |
Business Fax Number: | |
Mailing Address: | 44 Maritime Drive, MYSTIC |
State: | CT |
Postal Code: | 06355 |
Phone Number: | 8605721700 |
Fax Number: | |
NPI Enumeration Date: | 10/09/2014 |
NPI Last Update Date: | 10/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251G0304X |
License Number: | 007696 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Geriatrics |
Taxonomy Definition: |