Healthcare Provider Details

I. General information

NPI: 1699955690
Provider Name (Legal Business Name): MASSAGE AWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 OSTERVILLE WEST BARNSTABLE RD
OSTERVILLE MA
02655-1549
US

IV. Provider business mailing address

10 OSTERVILLE WEST BARNSTABLE RD
OSTERVILLE MA
02655-1549
US

V. Phone/Fax

Practice location:
  • Phone: 508-737-1147
  • Fax:
Mailing address:
  • Phone: 508-737-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. LOUISA GRAUEL
Title or Position: MANAGER
Credential: LMT
Phone: 508-737-1147