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General NPI Number Information
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NPI Number | 1902153380
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Entity Type | Organization
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Legal Business Name | BOSTON PAIN RELIEF MASSAGE THERAPY
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 76 SUMMER ST STE 220
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City | BOSTON
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State | MA
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Zip | 02110-1273
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Country | US
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Telephone | 508-330-6448
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Fax |
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Provider Business Mailing Address
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Address Line | 23 KINGS VIEW RD
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1547
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Country | US
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Telephone | 508-330-6448
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LUCY LU ALLEN
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Credential | LMT
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Telephone | 508-330-6448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | LMT9145
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License Number State | MA
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