Healthcare Provider Details

I. General information

NPI: 1861897464
Provider Name (Legal Business Name): MASSAGE MATRIX RI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 DANIELSON PIKE
N SCITUATE RI
02857
US

IV. Provider business mailing address

200 LAPHAM FARM RD
PASCOAG RI
02859-4001
US

V. Phone/Fax

Practice location:
  • Phone: 401-651-7375
  • Fax:
Mailing address:
  • Phone: 401-651-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT01946
License Number StateRI

VIII. Authorized Official

Name: MS. MARIE R CAPPUCCIO
Title or Position: OWNER/CLMT
Credential: CLMT
Phone: 401-651-7375