Provider Demographics
NPI:1164568663
Name:SCIALLA, LISA M (DPT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:SCIALLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:SCIALLA GRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:114 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1746
Mailing Address - Country:US
Mailing Address - Phone:617-752-4138
Mailing Address - Fax:617-752-4127
Practice Address - Street 1:379 W BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2217
Practice Address - Country:US
Practice Address - Phone:617-752-4138
Practice Address - Fax:617-752-4127
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y68632Medicare PIN