Healthcare Provider Details

I. General information

NPI: 1336784974
Provider Name (Legal Business Name): JOSEFINA URENA LMT, RT (R)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 ANDOVER ST STE G4
NORTH ANDOVER MA
01845-5077
US

IV. Provider business mailing address

69 PLEASANT ST # 2
LAWRENCE MA
01841-2243
US

V. Phone/Fax

Practice location:
  • Phone: 978-590-7292
  • Fax:
Mailing address:
  • Phone: 978-590-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14488
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: