Provider Demographics
NPI:1598978595
Name:VELAZQUEZ CUNNINGHAM, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:VELAZQUEZ CUNNINGHAM
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 1:91 WEARE RD
Mailing Address - Street 2:ROUTE 114
Mailing Address - City:HENNIKER
Mailing Address - State:NH
Mailing Address - Zip Code:03242-3437
Mailing Address - Country:US
Mailing Address - Phone:603-206-0154
Mailing Address - Fax:
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-228-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0491225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant