=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134425879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH NUNES LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2011
-----------------------------------------------------
Last Update Date | 01/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 LINCOLN ST SUITE 311
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01880-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-538-7395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 FRANKLIN ST
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01880-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 813662
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------