=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699955690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASSAGE AWAY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2007
-----------------------------------------------------
Last Update Date | 11/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 OSTERVILLE WEST BARNSTABLE RD
-----------------------------------------------------
City | OSTERVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02655-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-737-1147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 OSTERVILLE WEST BARNSTABLE RD
-----------------------------------------------------
City | OSTERVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02655-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-737-1147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. LOUISA GRAUEL
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 508-737-1147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------