Healthcare Provider Details

I. General information

NPI: 1275309353
Provider Name (Legal Business Name): BRAIN JUNCTION THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 WALNUT AVE
NORTH HAMPTON NH
03862-2011
US

IV. Provider business mailing address

76 WALNUT AVE
NORTH HAMPTON NH
03862-2011
US

V. Phone/Fax

Practice location:
  • Phone: 978-804-8831
  • Fax:
Mailing address:
  • Phone: 978-804-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA THERESE BLATUS
Title or Position: CEO/OWNER AND OPERATOR
Credential: OTD, OTR/L, M. ED.
Phone: 978-225-0918