Provider Demographics
NPI:1528049137
Name:LACKENBY, BRIANA DILLING (DPT)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:DILLING
Last Name:LACKENBY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DEVON LN
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1893
Mailing Address - Country:US
Mailing Address - Phone:508-776-9002
Mailing Address - Fax:
Practice Address - Street 1:135 DEVON LN
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-1893
Practice Address - Country:US
Practice Address - Phone:508-776-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68869Medicare ID - Type Unspecified