Individual
LISA VIVIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.P.T.
Contact information
Practice address
933 E COLUMBUS AVE, SPRINGFIELD, MA 01105-2509
(413) 301-6019
Mailing address
933 E COLUMBUS AVE, SPRINGFIELD, MA 01105-2509
(413) 301-6019
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
007615
CT
225100000X
Physical Therapist
Primary
5487
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0365611
—
MA
01
—
Y66095
BLUECROSS/BLUESHIELD
MA
Enumeration date
10/26/2005
Last updated
06/05/2014
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