=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669263125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORETO ALEJANDRA RUIZ MT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2025
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 MAIN ST STE 253
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01002-2346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-997-5748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 WEST ST APT 19
-----------------------------------------------------
City | WARE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01082-9784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-997-5748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 11512
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------