Mr. CHRISTOPHER GLEN ILACQUA M.D.
Individual Provider (NPI-1)
Active
Physical Medicine & Rehabilitation
Provider Information
- NPI Number
1528291127- Provider Type
- Individual Provider (NPI-1)
- Credentials
- M.D.
- Status
- Active
Contact & Location
- Address
- 100 SOUTH ST, SOUTHBRIDGE, MA, 015504051
- Phone
- (508) 909-8590
- Fax
- (508) 909-8589
Specialties & Taxonomies
Specialist/Technologist, Athletic Trainer
License: MA #2015
Physical Medicine & Rehabilitation
License: PA #MD467051
Physical Medicine & Rehabilitation
Primary License: MA #1017464
All Addresses
MAILING
PO BOX 415348
BOSTON, MA, 022415348