Basic Information
| Provider Information | |||||||||
| NPI: | 1568895928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURILLO | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CREDIT UNION WAY FL 3 | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023684633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819613370 | ||||||||
| FaxNumber: | 7819611291 | ||||||||
| Practice Location | |||||||||
| Address1: | 156 ANDOVER ST UNIT 2 | ||||||||
| Address2: | |||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019231468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787678343 | ||||||||
| FaxNumber: | 9787678349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0361401 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 21382 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4731307 | 01 | MA | AETNA | OTHER | 110110058A | 05 | MA | MEDICAID | 1233079 | 01 | MA | AMERICAN SPECIALTY HEALTH (ASHCIGNA) | OTHER | 233423 | 01 | MA | TUFTS HEALTH PLANS- COMMERCIAL PLANS | OTHER | 877138 | 01 | MA | OPTUM/UNITED HEALTH CARE | OTHER |