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General NPI Number Information
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NPI Number | 1740500933
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Entity Type | Organization
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Legal Business Name | THE SPA AT BONCALDO'S
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 76 BEALE ST
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City | WOLLASTON
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State | MA
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Zip | 02170-2617
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Country | US
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Telephone | 617-471-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 76 BEALE STREET
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City | WOLLASTON
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State | MA
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Zip | 02170
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Country | US
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Telephone | 617-471-9515
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Fax |
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Authorized Official
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Title or Position | OWNER/MANGER
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Name | MS. ALYSE NANCY BAKER-BONCALDO
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Credential |
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Telephone | 617-471-9515
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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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