Provider Demographics
NPI:1396990420
Name:CIBOTTI, LAWRENCE ROBERT (PTA)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:CIBOTTI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2209
Mailing Address - Country:US
Mailing Address - Phone:781-297-0979
Mailing Address - Fax:781-297-3703
Practice Address - Street 1:57 FRENCH ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2209
Practice Address - Country:US
Practice Address - Phone:781-297-0979
Practice Address - Fax:781-297-3703
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4017225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant