Healthcare Provider Details

I. General information

NPI: 1902209828
Provider Name (Legal Business Name): ORTHOMED MASSAGE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 WEST MAIN ST SUITE 1B
NORTHBOROUGH MA
01532-2381
US

IV. Provider business mailing address

269 W MAIN ST STE 1B
NORTHBOROUGH MA
01532-2382
US

V. Phone/Fax

Practice location:
  • Phone: 508-466-8257
  • Fax: 508-393-6030
Mailing address:
  • Phone: 508-466-8257
  • Fax: 508-393-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARYANN REID
Title or Position: OWNER
Credential: LMT
Phone: 508-466-8257