Provider Demographics
NPI:1053565408
Name:VIVEIROS, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:VIVEIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MOUNTFAIR CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-1000
Mailing Address - Country:US
Mailing Address - Phone:508-674-2744
Mailing Address - Fax:
Practice Address - Street 1:907 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764-1710
Practice Address - Country:US
Practice Address - Phone:508-669-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6030225200000X
NH0929225200000X
RIPTA00474225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant