Healthcare Provider Details

I. General information

NPI: 1538608344
Provider Name (Legal Business Name): CHRISTINA DEGIROLAMO L.A.T, A.T.C, L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HIGHLAND CIR
NEEDHAM MA
02494-3099
US

IV. Provider business mailing address

1166 WEST ST
MANSFIELD MA
02048-1038
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-3609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2744
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14334
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: