Healthcare Provider Details

I. General information

NPI: 1194055343
Provider Name (Legal Business Name): ENERGIZING 'N TOUCH MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST SUITE 8
INDIAN ORCHARD MA
01151-1228
US

IV. Provider business mailing address

529 MAIN ST SUITE 8
INDIAN ORCHARD MA
01151-1228
US

V. Phone/Fax

Practice location:
  • Phone: 413-657-7425
  • Fax:
Mailing address:
  • Phone: 413-657-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5622
License Number StateMA

VIII. Authorized Official

Name: CARDINAL PARKER
Title or Position: OWNER PARTNER/ MASSAGE THERAPIST
Credential:
Phone: 413-657-7425