Healthcare Provider Details

I. General information

NPI: 1972171361
Provider Name (Legal Business Name): MICHAEL PATRICK DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 WORCESTER RD STE 101
FRAMINGHAM MA
01702-5248
US

IV. Provider business mailing address

35 GOODNOW LN
FRAMINGHAM MA
01702-5575
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-8882
  • Fax:
Mailing address:
  • Phone: 508-259-2903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16492
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: