Healthcare Provider Details

I. General information

NPI: 1659622942
Provider Name (Legal Business Name): REBECCA M GWOZDZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HIGH ST SUITE 2B
HOLYOKE MA
01040-3739
US

IV. Provider business mailing address

850 HIGH ST SUITE 2B
HOLYOKE MA
01040-3739
US

V. Phone/Fax

Practice location:
  • Phone: 413-536-0142
  • Fax: 413-536-0607
Mailing address:
  • Phone: 413-536-0142
  • Fax: 413-536-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10922
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: