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General NPI Number Information
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NPI Number | 1922891720
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Entity Type | Individual
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Provider Name | RONNIE WASHINGTON III MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 250 POMEROY AVE SUITE 201F
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City | MERIDEN
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State | CT
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Zip | 06450
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Country | US
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Telephone | 475-307-8156
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Fax |
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Provider Business Mailing Address
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Address Line | 192 CENTER ST APT 7
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City | WALLINGFORD
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State | CT
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Zip | 06492-4147
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Country | US
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Telephone | 475-307-8156
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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 | 011429
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License Number State | CT
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