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General NPI Number Information
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NPI Number | 1609534346
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Entity Type | Organization
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Legal Business Name | MYOMEDICINE, LLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 90 CONZ ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3881
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Country | US
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Telephone | 413-320-4811
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Fax |
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Provider Business Mailing Address
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Address Line | 24 OLD LONG PLAIN RD
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City | LEVERETT
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State | MA
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Zip | 01054-9519
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Country | US
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Telephone | 413-320-4811
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MELISSA COLBERT
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Credential | MD
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Telephone | 413-320-4811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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