Healthcare Provider Details

I. General information

NPI: 1720103666
Provider Name (Legal Business Name): HAMPSHIRE MYOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 OLD AMHERST DR
BELCHERTOWN MA
01007
US

IV. Provider business mailing address

PO BOX 905
FALMOUTH MA
02541
US

V. Phone/Fax

Practice location:
  • Phone: 413-253-9777
  • Fax: 413-253-7290
Mailing address:
  • Phone: 508-548-8989
  • Fax: 508-548-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number043366935
License Number StateMA

VIII. Authorized Official

Name: SHEILA SOUZA
Title or Position: BILLING AGENT CEO
Credential:
Phone: 508-548-8989