Provider Demographics
NPI:1699104471
Name:LASDIN, MARY (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LASDIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-1346
Mailing Address - Country:US
Mailing Address - Phone:978-664-5597
Mailing Address - Fax:
Practice Address - Street 1:1364 MAIN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-1137
Practice Address - Country:US
Practice Address - Phone:781-942-1210
Practice Address - Fax:781-942-7251
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist