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General NPI Number Information
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NPI Number | 1114363348
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Entity Type | Organization
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Legal Business Name | MEDICAL MASSAGE REHAB
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 2049 SILAS DEANE HWY SUITE 202
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City | ROCKY HILL
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State | CT
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Zip | 06067-2332
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Country | US
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Telephone | 860-721-0249
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Fax |
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Provider Business Mailing Address
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Address Line | 2049 SILAS DEANE HWY SUITE 202
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City | ROCKY HILL
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State | CT
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Zip | 06067-2332
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Country | US
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Telephone | 860-721-0249
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE R JOYNER
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Credential | LMT. MMP
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Telephone | 860-721-0249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 6568
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License Number State | CT
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