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General NPI Number Information
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NPI Number | 1639760879
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Entity Type | Organization
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Legal Business Name | A TIME AWAY
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Dates
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Enumeration Date | 01/31/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 154 BROAD ST STE 1532
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City | NASHUA
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State | NH
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Zip | 03063-3205
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Country | US
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Telephone | 603-263-4725
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Fax |
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Provider Business Mailing Address
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Address Line | 244 S MERRIMACK RD
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City | HOLLIS
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State | NH
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Zip | 03049
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Country | US
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Telephone | 603-689-6438
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Fax |
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Authorized Official
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Title or Position | OWNER / MASSAGE THERAPIST
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Name | JANE K LARSON
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Credential |
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Telephone | 603-689-6438
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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 |
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License Number State |
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