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General NPI Number Information
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NPI Number | 1912404682
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Entity Type | Organization
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Legal Business Name | INNER HORIZON SPAWORKS LLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 701 WASHINGTON ST STE B2
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City | NEWTON
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State | MA
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Zip | 02458-1386
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Country | US
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Telephone | 617-340-9340
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Fax |
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Provider Business Mailing Address
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Address Line | 701 WASHINGTON ST STE B2
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City | NEWTON
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State | MA
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Zip | 02458-1386
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Country | US
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Telephone | 617-340-9340
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER BRADBURY
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Credential | LMT
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Telephone | 617-467-6802
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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 | 1872
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License Number State | MA
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