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General NPI Number Information
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NPI Number | 1861530602
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Entity Type | Organization
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Legal Business Name | EARTH ELEMENT CLINICAL & THERAPEUTIC MASSAGE, LLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2030 STRAITS TPKE
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City | MIDDLEBURY
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State | CT
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Zip | 06762-1831
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Country | US
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Telephone | 203-578-0831
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Fax |
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Provider Business Mailing Address
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Address Line | 105 WESTBURY PARK RD
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City | WATERTOWN
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State | CT
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Zip | 06795-2766
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Country | US
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Telephone |
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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 | JULIE OSTUNO
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Credential |
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Telephone | 203-578-0831
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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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