Healthcare Provider Details

I. General information

NPI: 1306283379
Provider Name (Legal Business Name): CONNIE L MESSER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OLD RUNNELLS BRIDGE RD
HOLLIS NH
03049-6516
US

IV. Provider business mailing address

17 OLD RUNNELLS BRIDGE RD
HOLLIS NH
03049-6516
US

V. Phone/Fax

Practice location:
  • Phone: 603-459-4972
  • Fax:
Mailing address:
  • Phone: 603-459-4972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2714M
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: