Provider Demographics
NPI:1366893661
Name:LITSKY GAETH, LIANA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:LITSKY GAETH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:RUTH
Other - Last Name:LITSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 H F BROWN WAY
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3889
Mailing Address - Country:US
Mailing Address - Phone:508-647-1633
Mailing Address - Fax:
Practice Address - Street 1:1 H F BROWN WAY
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3889
Practice Address - Country:US
Practice Address - Phone:508-647-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22166OtherBOARD OF ALLIED HEALTH PROFESSIONS