Healthcare Provider Details

I. General information

NPI: 1831764943
Provider Name (Legal Business Name): BRAIN BODY SYNERGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 PARKER ST
MAYNARD MA
01754-2133
US

IV. Provider business mailing address

189 PARKER ST
MAYNARD MA
01754-2133
US

V. Phone/Fax

Practice location:
  • Phone: 617-308-0713
  • Fax:
Mailing address:
  • Phone: 617-308-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA OKUN
Title or Position: OWNER
Credential:
Phone: 617-308-0713