Healthcare Provider Details

I. General information

NPI: 1508114539
Provider Name (Legal Business Name): JAMES LIEBKE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 NEWBURYPORT TPKE STE A8
ROWLEY MA
01969-2132
US

IV. Provider business mailing address

PO BOX 633
ROWLEY MA
01969-3633
US

V. Phone/Fax

Practice location:
  • Phone: 978-948-7222
  • Fax: 978-948-7224
Mailing address:
  • Phone: 978-948-7222
  • Fax: 978-948-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: