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General NPI Number Information
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NPI Number | 1316416985
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Entity Type | Organization
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Legal Business Name | GREAT WAY WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 278 ELM ST STE 227
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City | SOMERVILLE
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State | MA
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Zip | 02144-2919
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Country | US
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Telephone | 617-852-0690
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440045
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City | SOMERVILLE
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State | MA
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Zip | 02144-0001
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Country | US
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Telephone | 617-852-0690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE E THOMASON
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Credential | LIC.AC.
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Telephone | 617-852-0690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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