Healthcare Provider Details

I. General information

NPI: 1295136364
Provider Name (Legal Business Name): PAMELA MURGO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 PUTNAM PIKE
CHEPACHET RI
02814-1962
US

IV. Provider business mailing address

PO BOX 1089 1187 PUTNAM PIKE
CHEPACHET RI
02814
US

V. Phone/Fax

Practice location:
  • Phone: 401-569-8080
  • Fax:
Mailing address:
  • Phone: 401-569-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT01848
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9619-MT
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: