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General NPI Number Information
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NPI Number | 1114281318
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Entity Type | Individual
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Provider Name | JARED C THOMAS LMT,CPT
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Gender | Male
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 161 EASTERN AVE
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City | LYNN
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State | MA
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Zip | 01902-1307
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Country | US
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Telephone | 857-249-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 162 WALNUT ST APT 1
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City | LYNN
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State | MA
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Zip | 01905-1157
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Country | US
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Telephone | 857-249-0232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 156890
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License Number State | MA
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