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General NPI Number Information
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NPI Number | 1740872639
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Entity Type | Individual
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Provider Name | AMY ERICSON MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 159 SAMOSET ST
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City | PLYMOUTH
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State | MA
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Zip | 02360-4815
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Country | US
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Telephone | 508-273-5332
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Fax |
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Provider Business Mailing Address
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Address Line | 1 KING AVE
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City | PLYMOUTH
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State | MA
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Zip | 02360-4231
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Country | US
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Telephone | 508-273-5332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11167
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License Number State | MA
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