Healthcare Provider Details

I. General information

NPI: 1174011746
Provider Name (Legal Business Name): SUSAN BUETI HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SODEN ST
CAMBRIDGE MA
02139-3154
US

IV. Provider business mailing address

14 SODEN ST
CAMBRIDGE MA
02139-3154
US

V. Phone/Fax

Practice location:
  • Phone: 617-999-9384
  • Fax:
Mailing address:
  • Phone: 617-999-9384
  • Fax: 617-999-9384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2777
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: