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General NPI Number Information
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NPI Number | 1730797226
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Entity Type | Organization
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Legal Business Name | INTEGRA WELLNESS HEALTH. PC
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 1077 LEXINGTON ST STE 203
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City | WALTHAM
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State | MA
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Zip | 02452-7233
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Country | US
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Telephone | 781-642-7934
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Fax | 781-642-7824
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Provider Business Mailing Address
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Address Line | 1077 LEXINGTON ST STE 203
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City | WALTHAM
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State | MA
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Zip | 02452-7233
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Country | US
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Telephone | 781-642-7934
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Fax | 781-643-7824
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Authorized Official
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Title or Position | OWNER
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Name | MR. JING LIU
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Credential | ACUPUNCTURIST
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Telephone | 781-642-7934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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