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General NPI Number Information
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NPI Number | 1326578311
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Entity Type | Individual
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Provider Name | SAMANTHA LEE GIGUERE MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 06/13/2017
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Provider Practice Location Address
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Address Line | 459 BROADWAY STE 204
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City | EVERETT
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State | MA
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Zip | 02149-3614
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Country | US
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Telephone | 877-655-2943
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Fax |
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Provider Business Mailing Address
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Address Line | 119 GRAND ST APT 2
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City | WOONSOCKET
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State | RI
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Zip | 02895-5821
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Country | US
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Telephone | 401-219-6029
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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 | 9037
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License Number State | MA
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