Provider Demographics
NPI:1588995781
Name:PANCHOLI, ANDREA LISA (LCMT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LISA
Last Name:PANCHOLI
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SAINT CAMILLE ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5100
Mailing Address - Country:US
Mailing Address - Phone:978-407-2099
Mailing Address - Fax:
Practice Address - Street 1:23 VILLAGE INN RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1660
Practice Address - Country:US
Practice Address - Phone:978-874-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist