Healthcare Provider Details

I. General information

NPI: 1124998976
Provider Name (Legal Business Name): GARRETT LEE RONCO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 LEBANON RD
ACTON ME
04001-4621
US

IV. Provider business mailing address

993 LEBANON RD
ACTON ME
04001-4621
US

V. Phone/Fax

Practice location:
  • Phone: 207-651-6380
  • Fax:
Mailing address:
  • Phone: 207-651-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8141
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: