=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316266224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORATION MASSAGE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2010
-----------------------------------------------------
Last Update Date | 05/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 N MAIN ST
-----------------------------------------------------
City | ASSONET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02702-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-644-1622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 65 N MAIN ST
-----------------------------------------------------
City | ASSONET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02702-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-644-1622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LISA ARONOFSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 774-451-1153
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT3MM
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------