Healthcare Provider Details

I. General information

NPI: 1770447146
Provider Name (Legal Business Name): MASSAGE BALANCE MASSAGE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WATERMAN AVE
EAST PROVIDENCE RI
02914-2611
US

IV. Provider business mailing address

305 WATERMAN AVE
EAST PROVIDENCE RI
02914-2611
US

V. Phone/Fax

Practice location:
  • Phone: 401-551-1904
  • Fax: 401-434-1278
Mailing address:
  • Phone: 401-551-1904
  • Fax: 401-434-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: VANESSA TAURISANO
Title or Position: OWNER
Credential:
Phone: 401-551-1904