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General NPI Number Information
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NPI Number | 1629963442
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Entity Type | Individual
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Provider Name | COLLEEN LYNN BOLES LMT
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 25 SCHOOL ST STE B2
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City | QUINCY
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State | MA
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Zip | 02169-6665
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Country | US
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Telephone | 617-689-0440
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Fax | 617-689-0420
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Provider Business Mailing Address
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Address Line | 33 RIDGECREST TER APT 1
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City | WEST ROXBURY
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State | MA
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Zip | 02132-5241
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Country | US
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Telephone | 857-347-6757
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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 | 2531
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License Number State | MA
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